MEDICARE: TRUE REHAB OF ARIZONA,LLC

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	261QP2000X	Physical Therapy Clinic/Center	OTC3718	AZ

General Provider Information

NPI Number	:	1801941992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE REHAB OF ARIZONA,LLC

Provider Business Mailing Address
First Line	:	1720 MESQUITE AVE STE 101
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5602
Country	:	US
Telephone Number	:	928-453-0501
Fax Number	:	928-453-0502

Provider Business Practice Location Address
First Line	:	297 LAKE HAVASU AVE S STE 102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6526
Country	:	US
Telephone Number	:	928-453-0501
Fax Number	:	928-453-0502

Authorized Official
Title or Position	:	OWNER
Name	:	TOM BENNETCH
Credential	:	P.T.
Telephone Number	:	928-453-0501

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/27/2021

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