Provider Demographics
NPI:1396973145
Name:PRO-BODY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:PRO-BODY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:909-902-5049
Mailing Address - Street 1:3110 CHINO AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1211
Mailing Address - Country:US
Mailing Address - Phone:909-902-5049
Mailing Address - Fax:909-902-5059
Practice Address - Street 1:3110 CHINO AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1211
Practice Address - Country:US
Practice Address - Phone:909-902-5049
Practice Address - Fax:909-902-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty