Provider Demographics
NPI:1518052935
Name:INGLIS, ROBERT JONATHAN (MPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JONATHAN
Last Name:INGLIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 E BIRCH ST
Mailing Address - Street 2:STE 160
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6218
Mailing Address - Country:US
Mailing Address - Phone:714-528-9400
Mailing Address - Fax:714-528-9403
Practice Address - Street 1:1804 N. PLACENTIA AVE.
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-2303
Practice Address - Country:US
Practice Address - Phone:714-528-9400
Practice Address - Fax:714-528-9403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25208CMedicare ID - Type UnspecifiedMEDICARE
CAY07573Medicare UPIN