Provider Demographics
NPI:1154564789
Name:THERAPEUTIC MEDXPRO, INC.
Entity type:Organization
Organization Name:THERAPEUTIC MEDXPRO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-528-0776
Mailing Address - Street 1:16689 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8414
Mailing Address - Country:US
Mailing Address - Phone:909-528-0776
Mailing Address - Fax:
Practice Address - Street 1:16689 FOOTHILL BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8414
Practice Address - Country:US
Practice Address - Phone:909-528-0776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21422225100000X
CAPT33236225100000X
CAPT28321225100000X
CAOT9783225X00000X
CAOT5549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28321OtherCALIFORNIA PHYSICAL THERAPY LICENSE