Provider Demographics
NPI:1982912267
Name:VALLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLITO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:909-885-7200
Mailing Address - Street 1:688 N ARROWHEAD AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1144
Mailing Address - Country:US
Mailing Address - Phone:909-885-7200
Mailing Address - Fax:909-885-7272
Practice Address - Street 1:688 N ARROWHEAD AVE STE 101B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1144
Practice Address - Country:US
Practice Address - Phone:909-885-7200
Practice Address - Fax:909-885-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 21672OtherPHYSICAL THERAPY BOARD OF CALIFORNIA