Provider Demographics
NPI:1205869070
Name:TEAM PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:TEAM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEKENDAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-948-1124
Mailing Address - Street 1:7945 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3066
Mailing Address - Country:US
Mailing Address - Phone:909-948-1124
Mailing Address - Fax:909-948-1104
Practice Address - Street 1:7945 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3066
Practice Address - Country:US
Practice Address - Phone:909-948-1124
Practice Address - Fax:909-948-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14201261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT142010Medicare ID - Type Unspecified