Basic Information
| Provider Information | |||||||||
| NPI: | 1619387453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZENTHOEFER | ||||||||
| FirstName: | JOHN-PETER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6177 RIVER CREST DR | ||||||||
| Address2: | #A | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925070728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6177 RIVER CREST DR | ||||||||
| Address2: | #A | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925070728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516534480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2014 | ||||||||
| LastUpdateDate: | 08/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT 40783 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | PTL.0014183 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT 40783 | 01 | CA | PT LICENSE | OTHER |