Provider Demographics
NPI:1982630455
Name:CHAPARRAL PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CHAPARRAL PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-256-1888
Mailing Address - Street 1:15555 MAIN ST
Mailing Address - Street 2:STE 14A
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3466
Mailing Address - Country:US
Mailing Address - Phone:760-244-4288
Mailing Address - Fax:760-244-0300
Practice Address - Street 1:15555 MAIN ST
Practice Address - Street 2:STE 14A
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3466
Practice Address - Country:US
Practice Address - Phone:760-244-4288
Practice Address - Fax:760-244-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PT129400Medicare PIN