Provider Demographics
NPI:1669787495
Name:ARROYO PHYSICAL THERAPY
Entity type:Organization
Organization Name:ARROYO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:323-401-1408
Mailing Address - Street 1:12241 INDUSTRIAL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8301
Mailing Address - Country:US
Mailing Address - Phone:800-489-6905
Mailing Address - Fax:800-489-6905
Practice Address - Street 1:1720 E WASHINGTON BLVD
Practice Address - Street 2:208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2779
Practice Address - Country:US
Practice Address - Phone:626-593-2283
Practice Address - Fax:626-593-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37027261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA120436OtherUNSPECIFIED
CACA120436OtherPTAN
CACA124469OtherUNSPECIFIED
CACA124469OtherPTAN
CACA120436OtherUNSPECIFIED
CACA120436OtherPTAN
CACA124469OtherUNSPECIFIED