Provider Demographics
NPI:1093873887
Name:REGISTERED PHYSICAL THERAPY PROVIDERS, INC.
Entity Type:Organization
Organization Name:REGISTERED PHYSICAL THERAPY PROVIDERS, INC.
Other - Org Name:BLUE JAY PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:BEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-337-4192
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-0784
Mailing Address - Country:US
Mailing Address - Phone:909-337-4192
Mailing Address - Fax:909-336-1982
Practice Address - Street 1:26571 ST. HWY 18
Practice Address - Street 2:SUITE B
Practice Address - City:RIMFOREST
Practice Address - State:CA
Practice Address - Zip Code:92378-0010
Practice Address - Country:US
Practice Address - Phone:909-337-4192
Practice Address - Fax:909-336-1982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGISTERED PHYSICAL THERAPY PROVIDERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty