MEDICARE: GOOD SHEPHERD REHABILITATION RESEARCH INSTITUTE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251C2600X	Cardiopulmonary Physical Therapist	1006252924	NV

General Provider Information

NPI Number	:	1558592493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD REHABILITATION RESEARCH INSTITUTE INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 26299
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:	702-893-0960

Provider Business Practice Location Address
First Line	:	7455 W. WASHINGTON AVE.
Second Line	:	SUITE# 185
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:	702-893-0960

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAUL A. ABEJUELA
Credential	:
Telephone Number	:	702-893-3333

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/27/2009

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