Provider Demographics
NPI:1437182060
Name:INFINITE PHYSICAL THERAPY
Entity type:Organization
Organization Name:INFINITE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-776-1911
Mailing Address - Street 1:71847 HIGHWAY 111
Mailing Address - Street 2:SUITE C
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-6406
Mailing Address - Country:US
Mailing Address - Phone:760-776-1911
Mailing Address - Fax:760-776-4833
Practice Address - Street 1:71847 HIGHWAY 111
Practice Address - Street 2:SUITE C
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-6406
Practice Address - Country:US
Practice Address - Phone:760-776-1911
Practice Address - Fax:760-776-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28048ZMedicare ID - Type Unspecified