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General NPI Number Information
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NPI Number | 1255301461
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Entity Type | Organization
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Legal Business Name | POMONA VALLEY ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 21015 PATHFINDER RD SUITE 100
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4018
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Country | US
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Telephone | 909-861-3511
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Fax | 909-860-7900
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Provider Business Mailing Address
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Address Line | 21015 PATHFINDER RD SUITE 100
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4018
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Country | US
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Telephone | 909-861-3511
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Fax | 909-860-7900
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Authorized Official
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Title or Position | OWNER,PRESIDENT
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Name | DR. GARY SOUZA
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Credential | DPT, OCS
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Telephone | 909-861-3511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT10462
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License Number State | CA
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