1235180886 NPI number — CALIFORNIA REHABILITATION & SPORTS THERAPY A CALIFORNIA PHYSICAL THER

Table of content: (NPI 1235180886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235180886 NPI number — CALIFORNIA REHABILITATION & SPORTS THERAPY A CALIFORNIA PHYSICAL THER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA REHABILITATION & SPORTS THERAPY A CALIFORNIA PHYSICAL THER
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:
Provider Other Organization Name Type Code:
6
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:
1235180886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 DALLAS PKWY STE 290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-7493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
945-050-0010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 N EUCLID ST
Provider Second Line Business Practice Location Address:
#680
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-5506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-780-0010
Provider Business Practice Location Address Fax Number:
714-780-0050
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PACE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
213-804-1712

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 16867 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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