Individual
ANDREW PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9900 INDIANA AVE STE 8, RIVERSIDE, CA 92503-5498
(951) 376-1120
Mailing address
6177 KIRK ST, RIVERSIDE, CA 92506-4636
(253) 431-8046
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60691657
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60691657
PT LICENSE
WA
01
—
PT304206
PT LICENSE
CA
Enumeration date
11/16/2016
Last updated
02/21/2024
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