Provider Demographics
NPI:1750500161
Name:UNITED THERAPY NETWORK INC
Entity Type:Organization
Organization Name:UNITED THERAPY NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUDMUNDUR
Authorized Official - Middle Name:H
Authorized Official - Last Name:GUNNARSSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-825-6716
Mailing Address - Street 1:1230 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6450
Mailing Address - Country:US
Mailing Address - Phone:909-825-6716
Mailing Address - Fax:909-825-4339
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:SUITE 108
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-852-8803
Practice Address - Fax:626-852-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15205AMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID NO