| Organization Name: | FORTANASCE & ASSOCIATES SPORTS MEDICINE AND PHYSICAL THERAPY |
| NPI Number: | 1114952231 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL G FORTANASCE (OWNER PRESIDENT) |
| Mailing Address: | 1275 Foothill Blvd La Verne |
| State: | CA US |
| Postal Code: | 91750 |
| Phone Number: | 9095931200 |
| Fax Number: | 9095931899 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 00000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |