Provider Demographics
NPI:1508948837
Name:POWER CENTER PHYSICAL THERAPY INCORPORATED
Entity Type:Organization
Organization Name:POWER CENTER PHYSICAL THERAPY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SARDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-245-8828
Mailing Address - Street 1:17270 BEAR VALLEY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7751
Mailing Address - Country:US
Mailing Address - Phone:760-245-8828
Mailing Address - Fax:855-891-9996
Practice Address - Street 1:17270 BEAR VALLEY RD
Practice Address - Street 2:STE 105
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7751
Practice Address - Country:US
Practice Address - Phone:760-245-8828
Practice Address - Fax:855-891-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5557690001OtherDMERC
CADE2261OtherRAILROAD MEDICARE
CA5557690001OtherDMERC