Provider Demographics
NPI:1831137413
Name:HESPERIA PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:HESPERIA PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-949-3388
Mailing Address - Street 1:15235 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3326
Mailing Address - Country:US
Mailing Address - Phone:760-949-3388
Mailing Address - Fax:760-949-2262
Practice Address - Street 1:15235 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3326
Practice Address - Country:US
Practice Address - Phone:760-949-3388
Practice Address - Fax:760-949-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT143650261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26233ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID