Provider Demographics
NPI:1811326614
Name:INLAND PHYSICAL THERAPY AND SPINE CENTER, PC
Entity type:Organization
Organization Name:INLAND PHYSICAL THERAPY AND SPINE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESARI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:909-827-8846
Mailing Address - Street 1:7333 FOXGLOVE PL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3187
Mailing Address - Country:US
Mailing Address - Phone:909-452-7718
Mailing Address - Fax:909-452-7718
Practice Address - Street 1:7333 FOXGLOVE PL
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3187
Practice Address - Country:US
Practice Address - Phone:909-452-7718
Practice Address - Fax:909-452-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty