Provider Demographics
NPI:1073156964
Name:WINGS PHYSIOTHERAPY, INC.
Entity Type:Organization
Organization Name:WINGS PHYSIOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:REUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-659-5708
Mailing Address - Street 1:688 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-1026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18231 US HIGHWAY 18 STE 3
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2213
Practice Address - Country:US
Practice Address - Phone:909-659-5708
Practice Address - Fax:909-913-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy