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General NPI Number Information
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NPI Number | 1750975140
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Entity Type | Organization
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Legal Business Name | BLUE SKIES PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 20701 CEREAL ST SKYDIVE ELSINORE, TEAM ROOM 8
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-9253
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Country | US
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Telephone | 702-904-0178
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Fax |
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Provider Business Mailing Address
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Address Line | 24375 JACKSON AVE APT N308
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City | MURRIETA
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State | CA
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Zip | 92562-1916
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Country | US
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Telephone | 702-904-0178
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST, EMT-B
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Name | NANCY N GRIEGER
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Credential | PT, EMT
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Telephone | 702-904-0178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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