1134216294 NPI number — REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.

Table of content: (NPI 1134216294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134216294 NPI number — REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THERAPEEDS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134216294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3959 RUFFIN RD STE J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-279-5570
Provider Business Mailing Address Fax Number:
858-279-5303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3959 RUFFIN RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-5570
Provider Business Practice Location Address Fax Number:
858-279-5303
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO & PRESIDENT
Authorized Official Telephone Number:
858-279-5570

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT24080 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251P0200X , with the licence number: PT26678 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 601912800 . This is a "ACS US DEPT OF LABOR-DOL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 76332 . This is a "UCSD NETWORK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE SHIELD . This is a "ZZZ08081Z" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2196748 . This is a "FIRST HEALTH PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 643644 . This is a "CONNECTICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GPT001640 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007920691 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 8731210 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5514891 . This is a "CCN PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 573373 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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