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Organization
RANCHO PHYSICAL THERAPY, INC.
Active
Organization
RANCHO PHYSICAL THERAPY, INC.
Active
Other names
Rancho Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELA LITT (CREDENTIALING)
(951) 696-9353
Entity
Organization
Contact information
Practice address
31764 CASINO DR STE 106A&B, LAKE ELSINORE, CA 92530-2312
(951) 471-3300
(951) 471-3301
Mailing address
600 CENTRAL AVE STE C, LAKE ELSINORE, CA 92530-2740
(951) 696-9353
(951) 973-7216
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
CA
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407824162
—
CA
01
—
ZZZ05533Z
BLUE SHIELD - OT
CA
01
—
ZZZ60304Z
BLUE SHIELD - PT
CA
Enumeration date
03/09/2006
Last updated
03/14/2022
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