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Organization
RANCHO PHYSICAL THERAPY, INC.
Active
Organization
RANCHO PHYSICAL THERAPY, INC.
Active
Other names
OptimisSport PT
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELA LITT (CREDENTIALING COORDINATOR)
(951) 696-9353
Entity
Organization
Contact information
Practice address
910 VIA DE LA PAZ STE 101, PACIFIC PALISADES, CA 90272-3538
(310) 573-9340
(310) 573-9328
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ68108Y
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
06/17/2011
Last updated
03/14/2022
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