Healthcare Provider Details

I. General information

NPI: 1487694287
Provider Name (Legal Business Name): ANBERRY PHYSICAL REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SHAFFER ROSD
ATWATER CA
95301-4456
US

IV. Provider business mailing address

17011 BEACH BLVD. SUITE 1130
HUNTINGTON BEACH CA
92647-7402
US

V. Phone/Fax

Practice location:
  • Phone: 209-841-2083
  • Fax: 209-357-0904
Mailing address:
  • Phone: 714-841-2083
  • Fax: 866-837-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberZZZ32050Z
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberZZZ32050Z
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberZZZ32050Z
License Number StateCA

VIII. Authorized Official

Name: DONALD W. GORMLY JR.
Title or Position: PRESIDENT
Credential:
Phone: 714-841-3700