Provider Demographics
NPI:1942236351
Name:COFORDO, INC.
Entity Type:Organization
Organization Name:COFORDO, INC.
Other - Org Name:ORCHARD PLAZA THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT ASSISTANT
Authorized Official - Phone:909-941-7177
Mailing Address - Street 1:9116 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6564
Mailing Address - Country:US
Mailing Address - Phone:909-941-7177
Mailing Address - Fax:909-941-7179
Practice Address - Street 1:9116 FOOTHILL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6564
Practice Address - Country:US
Practice Address - Phone:909-941-7177
Practice Address - Fax:909-941-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA054543Medicare ID - Type UnspecifiedCORF