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Organization
PROVIDENCE PHYSICAL THERAPY, INC
Active
Organization
PROVIDENCE PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER M AZIZ RPT (DIRECTOR OF THERAPY)
(909) 773-0022
Entity
Organization
Contact information
Practice address
3550 E PHILADELPHIA ST, SUITE # 155, ONTARIO, CA 91761-2962
(909) 773-0022
(866) 672-8222
Mailing address
3550 E PHILADELPHIA ST, SUITE # 155, ONTARIO, CA 91761-2962
(909) 773-0022
(866) 672-8222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 15402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BL#67598
BUSINESS LICENSE NUMBER
CA
Enumeration date
04/20/2007
Last updated
08/22/2020
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