Healthcare Provider Details

I. General information

NPI: 1407162241
Provider Name (Legal Business Name): INNOVATION PHYSICAL THERAPY AND REHAB CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8227 SANTA INEZ WAY
BUENA PARK CA
90620-3158
US

IV. Provider business mailing address

8227 SANTA INEZ WAY
BUENA PARK CA
90620-3158
US

V. Phone/Fax

Practice location:
  • Phone: 714-496-1459
  • Fax:
Mailing address:
  • Phone: 714-496-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEFF D SALES
Title or Position: PRESIDENT
Credential: RPT
Phone: 714-496-1459