Provider Demographics
NPI:1417196817
Name:OPSVIG, TODD ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ALAN
Last Name:OPSVIG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15307 RIVER ROCK DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5346
Mailing Address - Country:US
Mailing Address - Phone:909-684-1255
Mailing Address - Fax:
Practice Address - Street 1:830 S CITRUS AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5911
Practice Address - Country:US
Practice Address - Phone:626-339-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist