Provider Demographics
NPI:1710297247
Name:DUCHENNE THERAPY NETWORK, A PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:DUCHENNE THERAPY NETWORK, A PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/P.T.
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-997-3134
Mailing Address - Street 1:PO BOX 811386
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90081
Mailing Address - Country:US
Mailing Address - Phone:909-997-3134
Mailing Address - Fax:909-494-4326
Practice Address - Street 1:1400 QUAIL ST
Practice Address - Street 2:UNIT 110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92662
Practice Address - Country:US
Practice Address - Phone:909-997-3134
Practice Address - Fax:909-494-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27874251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health