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General NPI Number Information
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NPI Number | 1508306234
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Entity Type | Organization
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Legal Business Name | CENTRAL CARE PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 4541 PHILADELPHIA ST C103
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City | CHINO
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State | CA
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Zip | 91710-3530
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Country | US
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Telephone | 909-590-7997
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2378
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City | CHINO HILLS
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State | CA
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Zip | 91709-0080
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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 | PHYSICAL THERAPIST
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Name | NICOLE RILEY
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Credential |
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Telephone | 909-590-7997
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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 | PT292704
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License Number State | CA
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