Provider Demographics
NPI:1740797349
Name:ALVILLAR EULBERG, THERESA (MPT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ALVILLAR EULBERG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:FOREST FALLS
Mailing Address - State:CA
Mailing Address - Zip Code:92339-0003
Mailing Address - Country:US
Mailing Address - Phone:909-649-2309
Mailing Address - Fax:
Practice Address - Street 1:40944 OAK DRIVE
Practice Address - Street 2:
Practice Address - City:FOREST FALLS
Practice Address - State:CA
Practice Address - Zip Code:92339
Practice Address - Country:US
Practice Address - Phone:951-505-8783
Practice Address - Fax:951-505-8783
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist