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General NPI Number Information
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NPI Number | 1427429554
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Entity Type | Organization
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Legal Business Name | EDGE PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 1599 MONTE VISTA AVE
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City | CLAREMONT
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State | CA
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Zip | 91711-2961
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Country | US
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Telephone | 909-399-3359
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Fax |
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Provider Business Mailing Address
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Address Line | 1599 MONTE VISTA AVE
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City | CLAREMONT
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State | CA
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Zip | 91711-2961
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Country | US
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Telephone | 909-399-3359
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT MILLER
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Credential |
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Telephone | 909-399-3359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 32957
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License Number State | CA
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