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General NPI Number Information
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NPI Number | 1790935567
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Entity Type | Organization
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Legal Business Name | EXTREME PERFORMANCE AND REHABILITATION,LLC
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 2205 W 23RD ST STE A
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City | YUMA
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State | AZ
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Zip | 85364-8869
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Country | US
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Telephone | 928-446-3473
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 W 23RD ST STE A
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City | YUMA
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State | AZ
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Zip | 85364-8869
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Country | US
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Telephone | 928-446-3473
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. OSCAR ESQUEDA JR.
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Credential | P.T.
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Telephone | 928-446-3473
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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 | 3395
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License Number State | AZ
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