Provider Demographics
NPI:1003562653
Name:DEMETRIOS SPINE AND WELLNESS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:DEMETRIOS SPINE AND WELLNESS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO ELAINE ROCHELLE
Authorized Official - Middle Name:MILO
Authorized Official - Last Name:AISPORNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:951-436-8064
Mailing Address - Street 1:31019 ROSE ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7139
Mailing Address - Country:US
Mailing Address - Phone:951-436-8064
Mailing Address - Fax:
Practice Address - Street 1:31019 ROSE ARBOR CT
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7139
Practice Address - Country:US
Practice Address - Phone:951-436-8064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy