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General NPI Number Information
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NPI Number | 1265210389
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Entity Type | Organization
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Legal Business Name | JORDAN RIVER PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 34247 YUCAIPA BLVD
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City | YUCAIPA
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State | CA
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Zip | 92399-6117
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Country | US
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Telephone | 909-528-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 35247 FUNK WAY
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City | BEAUMONT
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State | CA
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Zip | 92223-6279
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | FUAD AL-DABBAK
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Credential | MPH, MAED, CHES
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Telephone | 909-528-8288
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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 |
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License Number State |
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