Jordan River Physical Therapy Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

JORDAN RIVER PHYSICAL THERAPY INC

Practice address

34247 Yucaipa Blvd Ste E
Yucaipa, CA 92399-6118

Phone

(909) 657-2232

NPI assigned

Jul 22, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fuad Al-DabbakNPI 1366229585

Title

Manager

Phone

(909) 528-8288

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fuad Al-Dabbak, PT

  • Physical Therapist
  • Beaumont, CA
  • NPI 1366229585
  Medicare reassignment Care Compare group NPD Authorized official
• Faris Alshammari

  • Physical Therapist
  • Loma Linda, CA
  • NPI 1508287905
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1003798182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 386",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923990386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34247 YUCAIPA BLVD STE E",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923996118",
            "telephone_number": "909-657-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN RIVER PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-22",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "AL-DABBAK",
        "authorized_official_first_name": "FUAD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "909-528-8288"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA680529",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA687754",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordyn Nicole Jones
• Naudiya Y Jones
• Rachel Moriah Jones, LCSW
• Walter Jones III, M.D.
• Jordan River Physical Therapy
• Jorge Enciso, DDS, Inc.
• Michael Judah
• Julian M. Tudose, DDS, Inc
• Juniper Manor, LLC
• Avneet Kaur, MD

• Physical Therapy Clinic/Center in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.