Provider Demographics
NPI:1407180235
Name:PHYSIOTHERAPY INNOVATIONS
Entity Type:Organization
Organization Name:PHYSIOTHERAPY INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCMAINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:760-554-1244
Mailing Address - Street 1:1420 OCOTILLO DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4254
Mailing Address - Country:US
Mailing Address - Phone:760-554-1244
Mailing Address - Fax:760-482-0449
Practice Address - Street 1:1420 OCOTILLO DR
Practice Address - Street 2:SUITE D
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4254
Practice Address - Country:US
Practice Address - Phone:760-554-1244
Practice Address - Fax:760-482-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-26
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8047261QP2000X
CAPT 8074261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 8074Medicare PIN