MEDICARE: FORGED PHYSICAL THERAPY AND PERFORMANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1699482703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORGED PHYSICAL THERAPY AND PERFORMANCE

Provider Business Mailing Address
First Line	:	5160 RICHTON ST STE D
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5160 RICHTON ST STE D
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-1315
Country	:	US
Telephone Number	:	909-367-1257
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ZACH LEAL
Credential	:	PT, DPT, CSCS
Telephone Number	:	909-341-1050

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	12/13/2023

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Directions to “FORGED PHYSICAL THERAPY AND PERFORMANCE ” Practice Location

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