Provider Demographics
NPI:1386771517
Name:VANRIPER, MARK CHARLES (DPT, ATC, CSCS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHARLES
Last Name:VANRIPER
Suffix:
Gender:M
Credentials:DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 W TOWN AND COUNTRY RD
Mailing Address - Street 2:#1406
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4611
Mailing Address - Country:US
Mailing Address - Phone:714-504-4376
Mailing Address - Fax:
Practice Address - Street 1:6177 RIVER CREST DR STE A
Practice Address - Street 2:MCCUE CENTER 800 MASSIE ROAD
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0728
Practice Address - Country:US
Practice Address - Phone:951-653-4480
Practice Address - Fax:951-653-5051
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
CA38460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer