Provider Demographics
NPI:1164518437
Name:IEPTSIR, INC.
Entity Type:Organization
Organization Name:IEPTSIR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:FELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT,SCS,ATC,CSCS
Authorized Official - Phone:951-273-7742
Mailing Address - Street 1:1303 W 6TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3196
Mailing Address - Country:US
Mailing Address - Phone:951-273-7742
Mailing Address - Fax:951-273-7747
Practice Address - Street 1:1303 W 6TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3196
Practice Address - Country:US
Practice Address - Phone:951-273-7742
Practice Address - Fax:951-273-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624596261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01371ZMedicare ID - Type Unspecified