Healthcare Provider Details

I. General information

NPI: 1457434565
Provider Name (Legal Business Name): PHYSICAL REHABILITATION AND HAND CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E RAY RD STE 117
PHOENIX AZ
85044-6094
US

IV. Provider business mailing address

540 S ANDREASEN DR SUITE C/D
ESCONDIDO CA
92029-1917
US

V. Phone/Fax

Practice location:
  • Phone: 480-785-1043
  • Fax: 480-785-1124
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-294-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. DAVID C. BOUTELLE
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 760-591-7750