1073809273 NPI number — EXCEL PHYSICAL THERAPY AND WELLNESS

Table of content: DR. JOHN THOMAS RUSNOCK DMD (NPI 1245296037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073809273 NPI number — EXCEL PHYSICAL THERAPY AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL PHYSICAL THERAPY AND WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073809273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 TENNESSEE ST STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-8152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-792-5050
Provider Business Mailing Address Fax Number:
909-792-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 TENNESSEE ST STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-792-5050
Provider Business Practice Location Address Fax Number:
909-792-5051
Provider Enumeration Date:
06/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
909-910-0340

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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