Provider Demographics
NPI:1609407949
Name:REDHAWK PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:REDHAWK PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SCIRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:951-514-0728
Mailing Address - Street 1:31537 RANCHO PUEBLO RD STE 204
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4841
Mailing Address - Country:US
Mailing Address - Phone:951-514-0728
Mailing Address - Fax:951-639-0153
Practice Address - Street 1:31537 RANCHO PUEBLO RD STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4841
Practice Address - Country:US
Practice Address - Phone:951-514-0728
Practice Address - Fax:951-639-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty