MEDICARE: PREMIER REHABILITATION, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1790772531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER REHABILITATION, INC

Provider Business Mailing Address
First Line	:	339 STEALTH CT
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94551-9303
Country	:	US
Telephone Number	:	925-245-0100
Fax Number	:	925-245-0300

Provider Business Practice Location Address
First Line	:	11700 DUBLIN BLVD
Second Line	:	SUITE 100
City	:	DUBLIN
State	:	CA
Zip	:	94568-2822
Country	:	US
Telephone Number	:	925-803-0530
Fax Number	:	925-803-2047

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MITZI L HARRISON
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	925-245-0100

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	09/18/2008

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