Provider Demographics
NPI:1720406663
Name:NUEDGE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:NUEDGE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-262-2951
Mailing Address - Street 1:11804 SUMMERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2669
Mailing Address - Country:US
Mailing Address - Phone:909-262-2951
Mailing Address - Fax:
Practice Address - Street 1:11804 SUMMERWOOD CT
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2669
Practice Address - Country:US
Practice Address - Phone:909-262-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty