1396973145 NPI number — PRO-BODY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396973145 NPI number — PRO-BODY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO-BODY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
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:
PRO-BODY PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1396973145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3110 CHINO AVE
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
CHINO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91709-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-902-5049
Provider Business Mailing Address Fax Number:
909-902-5059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 CHINO AVE
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
CHINO HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91709-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-902-5049
Provider Business Practice Location Address Fax Number:
909-902-5059
Provider Enumeration Date:
06/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCCABE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT / PHYSICAL THERAPIST
Authorized Official Telephone Number:
909-902-5049

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 25555 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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