Provider Demographics
NPI:1619387453
Name:ZENTHOEFER, JOHN-PETER
Entity Type:Individual
Prefix:
First Name:JOHN-PETER
Middle Name:
Last Name:ZENTHOEFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 RIVER CREST DR
Mailing Address - Street 2:#A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0728
Mailing Address - Country:US
Mailing Address - Phone:951-653-4480
Mailing Address - Fax:
Practice Address - Street 1:6177 RIVER CREST DR
Practice Address - Street 2:#A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0728
Practice Address - Country:US
Practice Address - Phone:951-653-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40783208100000X
COPTL.0014183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 40783OtherPT LICENSE