Provider Demographics
NPI:1043852528
Name:PHOENIX PHYSICAL THERAPY AND WELLNESS INC
Entity type:Organization
Organization Name:PHOENIX PHYSICAL THERAPY AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSERI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:909-466-7363
Mailing Address - Street 1:11042 CHARLESTON ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-7714
Mailing Address - Country:US
Mailing Address - Phone:818-300-7169
Mailing Address - Fax:909-466-7365
Practice Address - Street 1:9555 FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3576
Practice Address - Country:US
Practice Address - Phone:909-466-7363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy