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General NPI Number Information
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NPI Number | 1881925600
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Entity Type | Organization
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Legal Business Name | TEAM THERAPY AND REHABILITATION, INC
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Dates
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Enumeration Date | 01/18/2010
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Last Update Date | 01/18/2010
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Provider Practice Location Address
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Address Line | 13024 HESPERIA RD SUITE 101
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City | VICTORVILLE
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State | CA
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Zip | 92395-8302
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Country | US
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Telephone | 760-951-4811
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Fax | 760-951-4833
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Provider Business Mailing Address
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Address Line | 13024 HESPERIA RD SUITE 101
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City | VICTORVILLE
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State | CA
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Zip | 92395-8302
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Country | US
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Telephone | 760-951-4811
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Fax | 760-951-4833
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW ADEDAPO ADESIDA
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Credential | P.A.
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Telephone | 760-951-4811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | AC12285
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License Number State | CA
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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 | DC27742
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License Number State | CA
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