=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629693619
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED THERAPY NETWORK INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2020
-----------------------------------------------------
Last Update Date | 07/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 CENTRAL AVE STE 145
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92506-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-297-3399
-----------------------------------------------------
Fax | 951-297-3404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1845 BUSINESS CENTER DR STE 127
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-890-9030
-----------------------------------------------------
Fax | 909-890-4393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT AND OWNER
-----------------------------------------------------
Name | MR. GUDMUNDUR HEIMER GUNNARSSON
-----------------------------------------------------
Credential | PT, CEO
-----------------------------------------------------
Telephone | 909-890-9030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------