Healthcare Provider Details

I. General information

NPI: 1083085278
Provider Name (Legal Business Name): CALIFORNIA REHAB & SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5962 LA PLACE CT # 150
CARLSBAD CA
92008-8807
US

IV. Provider business mailing address

5962 LA PLACE CT # 150
CARLSBAD CA
92008-8807
US

V. Phone/Fax

Practice location:
  • Phone: 760-607-9679
  • Fax: 760-602-3273
Mailing address:
  • Phone: 760-607-9679
  • Fax: 760-602-3273

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. JONATHAN EARL DOCKERY
Title or Position: VP RCM
Credential:
Phone: 760-607-9679