Provider Demographics
NPI:1841582756
Name:TEMECULA VALLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TEMECULA VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HUNTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:952-223-3956
Mailing Address - Street 1:36058 JOLTAIRE WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8741
Mailing Address - Country:US
Mailing Address - Phone:951-852-7964
Mailing Address - Fax:951-223-3956
Practice Address - Street 1:36058 JOLTAIRE WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8741
Practice Address - Country:US
Practice Address - Phone:951-852-7964
Practice Address - Fax:951-223-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27996261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT279962Medicare PIN