Provider Demographics
NPI:1851893101
Name:RENDONPHYSICAL THERAPY
Entity Type:Organization
Organization Name:RENDONPHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, DSC, PT
Authorized Official - Phone:909-796-4342
Mailing Address - Street 1:11544 ACACIA ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3505
Mailing Address - Country:US
Mailing Address - Phone:909-801-1223
Mailing Address - Fax:
Practice Address - Street 1:394 COMMERCIAL RD
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3708
Practice Address - Country:US
Practice Address - Phone:909-796-4342
Practice Address - Fax:909-494-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty