Provider Demographics
NPI:1164795761
Name:ABOVE AND BEYOND PHYSICAL THEARPY INC
Entity Type:Organization
Organization Name:ABOVE AND BEYOND PHYSICAL THEARPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SALZER-DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, CSCS
Authorized Official - Phone:909-289-0879
Mailing Address - Street 1:PO BOX 6523
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-6523
Mailing Address - Country:US
Mailing Address - Phone:909-289-0879
Mailing Address - Fax:909-866-7020
Practice Address - Street 1:42007 FOX FARM RD
Practice Address - Street 2:STE 2A
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-289-0879
Practice Address - Fax:909-866-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25817261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy