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General NPI Number Information
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NPI Number | 1598946410
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Entity Type | Organization
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Legal Business Name | DIRECT THERAPY
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 689 W FOOTHILL BLVD STE B
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City | CLAREMONT
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State | CA
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Zip | 91711-3400
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Country | US
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Telephone | 909-624-8244
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Fax | 909-624-8234
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Provider Business Mailing Address
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Address Line | 689 W FOOTHILL BLVD STE B
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City | CLAREMONT
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State | CA
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Zip | 91711-3400
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Country | US
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Telephone | 909-624-8244
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Fax | 909-624-8234
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Authorized Official
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Title or Position | DIRECTOR
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Name | THOMAS ALAN ARCHER
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Credential | M.S. RPT
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Telephone | 909-896-6094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 25575
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License Number State | CA
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