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General NPI Number Information
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NPI Number | 1396973145
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Entity Type | Organization
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Legal Business Name | PRO-BODY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 3110 CHINO AVE SUITE 270
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City | CHINO HILLS
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State | CA
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Zip | 91709-1211
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Country | US
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Telephone | 909-902-5049
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Fax | 909-902-5059
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Provider Business Mailing Address
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Address Line | 3110 CHINO AVE SUITE 270
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City | CHINO HILLS
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State | CA
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Zip | 91709-1211
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Country | US
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Telephone | 909-902-5049
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Fax | 909-902-5059
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Authorized Official
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Title or Position | PRESIDENT / PHYSICAL THERAPIST
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Name | DR. ERIC J. MCCABE
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Credential | D.P.T.
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Telephone | 909-902-5049
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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 | PT 25555
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License Number State | CA
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