Provider Demographics
NPI:1013699016
Name:FUNCTIONAL TRAINING AND REHAB PHYSIOTHERAPY P.C. INC.
Entity Type:Organization
Organization Name:FUNCTIONAL TRAINING AND REHAB PHYSIOTHERAPY P.C. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:949-202-9099
Mailing Address - Street 1:40679 BIG BEAR BOULEVARD
Mailing Address - Street 2:#3885
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40679 BIG BEAR BOULEVARD
Practice Address - Street 2:#3885
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:949-202-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation