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General NPI Number Information
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NPI Number | 1619278751
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Entity Type | Organization
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Legal Business Name | WEST COAST SPINE AND SPORTS THERAPY CENTER
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 6814 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2843
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Country | US
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Telephone | 951-774-0793
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Fax | 951-774-0783
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Provider Business Mailing Address
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Address Line | 6814 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2843
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Country | US
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Telephone | 951-774-0793
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Fax | 951-774-0783
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Authorized Official
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Title or Position | DIRECTOR
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Name | NANCY D KISHINO
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Credential | OT
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Telephone | 951-653-4480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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