Healthcare Provider Details

I. General information

NPI: 1659565315
Provider Name (Legal Business Name): ROXBURY REHAB INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 SANTA MONICA BLVD
BEVERLY HILLS CA
90210-4201
US

IV. Provider business mailing address

PO BOX 528
BEVERLY HILLS CA
90213-0528
US

V. Phone/Fax

Practice location:
  • Phone: 310-777-0097
  • Fax:
Mailing address:
  • Phone: 310-777-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GROSS
Title or Position: OWNER
Credential:
Phone: 310-777-0097