| Reform Physical Therapy, Inc. | |
|
264 N Highland Springs Ave Ste 5a Banning CA 92220-3083 | |
| (951) 769-0079 | |
| Not Available |
| Full Name | Reform Physical Therapy, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 264 N Highland Springs Ave Ste 5a, Banning, California |
| Authorized Official Name and Position | Robert Andrew Nelson (ADMINISTRATOR) |
| Authorized Official Contact | 9517690079 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reform Physical Therapy, Inc. 264 N Highland Springs Ave Ste 4 Banning CA 92220-3082 Ph: (951) 769-0079 | Reform Physical Therapy, Inc. 264 N Highland Springs Ave Ste 5a Banning CA 92220-3083 Ph: (951) 769-0079 |
| NPI Number | 1992723803 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 1951358522 |
|---|---|
| Medicare Enrollment ID | O20050405001442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992723803 | NPI | - | NPPES |
| GR0068300 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2000X | Clinic/center - Physical Therapy | (California) | Secondary |
| Provider Name | Frederick J Lloyd |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528053303 PECOS PAC ID: 2668472499 Enrollment ID: I20090520000380 |
| Provider Name | Patrick T Black |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1326439159 PECOS PAC ID: 5395065379 Enrollment ID: I20150514000743 |
| Provider Name | Theodore Eugene Wyman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083926919 PECOS PAC ID: 0345559571 Enrollment ID: I20151028002831 |
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