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Organization
PROSTAR SPORTS TRAINING AND REHABILITATION
Active
Organization
PROSTAR SPORTS TRAINING AND REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY M SOUZA DPT (OWNER/PRESIDENT)
(909) 861-3511
Entity
Organization
Contact information
Practice address
1370 VALLEY VISTA DR STE 145, DIAMOND BAR, CA 91765-3950
(909) 861-3511
(909) 860-7900
Mailing address
1370 VALLEY VISTA DR STE 145, DIAMOND BAR, CA 91765-3950
(909) 861-3511
(909) 860-7900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10462
CA
Other
Enumeration date
04/18/2008
Last updated
04/18/2008
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