Provider Demographics
NPI:1619096336
Name:PROTHERAPY, INC.
Entity Type:Organization
Organization Name:PROTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:QUIPANES
Authorized Official - Last Name:GUNNARSSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:909-856-3845
Mailing Address - Street 1:PO BOX 11268
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-1268
Mailing Address - Country:US
Mailing Address - Phone:909-856-3845
Mailing Address - Fax:909-863-9991
Practice Address - Street 1:137 E VINE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4759
Practice Address - Country:US
Practice Address - Phone:909-856-3845
Practice Address - Fax:909-863-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17159225100000X
CAPT26420225100000X
CAOT2416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT171591Medicare ID - Type UnspecifiedPHYSICAL THERAPY
CAZZZ25090ZMedicare ID - Type UnspecifiedOCCUPATIONAL THERAPY
CAZZZ25088ZMedicare ID - Type UnspecifiedPHYSICAL THERAPY
CA0PT264201Medicare ID - Type UnspecifiedPHYSICAL THERAPY