Provider Demographics
NPI:1205882875
Name:OUTBACK PHYSIOTHERAPY CENTRE, INC.
Entity type:Organization
Organization Name:OUTBACK PHYSIOTHERAPY CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-307-9121
Mailing Address - Street 1:1189 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8123
Mailing Address - Country:US
Mailing Address - Phone:909-307-9121
Mailing Address - Fax:909-307-9161
Practice Address - Street 1:1189 W STATE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8123
Practice Address - Country:US
Practice Address - Phone:909-307-9121
Practice Address - Fax:909-307-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy