1669787495 NPI number — ARROYO PHYSICAL THERAPY

Table of content: (NPI 1669787495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669787495 NPI number — ARROYO PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARROYO PHYSICAL THERAPY
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:
1669787495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12241 INDUSTRIAL BLVD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92395-8301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-489-6905
Provider Business Mailing Address Fax Number:
800-489-6905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 E WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
208
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91104-2779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-593-2283
Provider Business Practice Location Address Fax Number:
626-593-2284
Provider Enumeration Date:
08/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
323-401-1408

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT37027 , 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)

  • Identifier: CA120436 . This is a "UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA120436 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA124469 . This is a "UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA124469 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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