Provider Demographics
NPI:1316981038
Name:BEYOND FITNESS PHYSICAL THERAPY
Entity type:Organization
Organization Name:BEYOND FITNESS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ZEPHIA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-773-1144
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-773-1144
Mailing Address - Fax:760-773-2124
Practice Address - Street 1:71847 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-6406
Practice Address - Country:US
Practice Address - Phone:760-773-1144
Practice Address - Fax:760-773-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18012261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26856OtherKEVIN J. BUCKLEY
CAPT268560OtherCHRISTIAN E. SLOTTER, MPT
CAZZZ29694ZMedicare ID - Type UnspecifiedPROVIDER NUMBER