Organization
UP & MOVIN' PEDIATRIC PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANE LOREI SPICKELMIER PT (SECRETARY/TREASURER)
(951) 961-9152
Entity
Organization
Contact information
Practice address
6180 BROCKTON AVE, SUITE 202, RIVERSIDE, CA 92506-2228
(951) 961-9152
(951) 776-8028
Mailing address
17835 LUNA CT, RIVERSIDE, CA 92504-9523
(951) 961-9152
(951) 776-8028
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
PJ3678C
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487969051
NPPES
CA
Enumeration date
03/15/2011
Last updated
03/15/2011
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