Basic Information
| Provider Information | |||||||||
| NPI: | 1114952231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORTANASCE & ASSOCIATES SPORTS MEDICINE AND PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 NAOMI AVENUE | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264467027 | ||||||||
| FaxNumber: | 6264464723 | ||||||||
| Practice Location | |||||||||
| Address1: | 1275 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | LA VERNE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095931200 | ||||||||
| FaxNumber: | 9095931899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FORTANASCE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6264467027 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 00000 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.