Provider Demographics
NPI:1932303369
Name:CANYON RANCH PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CANYON RANCH PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:909-370-2270
Mailing Address - Street 1:7710 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9626
Mailing Address - Country:US
Mailing Address - Phone:909-370-2270
Mailing Address - Fax:909-370-2288
Practice Address - Street 1:7710 STEWART ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9626
Practice Address - Country:US
Practice Address - Phone:909-370-2270
Practice Address - Fax:909-370-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25067261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy