| Organization Name: | WIMBLEDON PARK PHYSICAL THERAPY |
| NPI Number: | 1366484131 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY HOPPER (MANAGER) |
| Mailing Address: | 12611 Hesperia Rd Ste B Victorville |
| State: | CA US |
| Postal Code: | 923957720 |
| Phone Number: | 7609519702 |
| Fax Number: | 7609518594 |
| NPI Enumeration Date: | 06/13/2006 |
| NPI Last Update Date: | 08/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT13643 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |