1841713625 NPI number — DYNAMIC PERFORMANCE PHYSICAL THERAPY INC

Table of content: (NPI 1841713625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841713625 NPI number — DYNAMIC PERFORMANCE PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC PERFORMANCE 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:
KORE 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:
1841713625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2377 W FOOTHILL BLVD STE 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-3584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-608-2800
Provider Business Mailing Address Fax Number:
909-608-2803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2377 W. FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
STE 20
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-608-2800
Provider Business Practice Location Address Fax Number:
909-608-2803
Provider Enumeration Date:
07/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WEINZAPFEL
Authorized Official First Name:
NINFA
Authorized Official Middle Name:
PILI
Authorized Official Title or Position:
CEO/ PHYSICAL THERAPIST
Authorized Official Telephone Number:
909-937-4556

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  20354 , 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)





Copyright © 2007-2024 www.npivalidator.com