Healthcare Provider Details

I. General information

NPI: 1134309768
Provider Name (Legal Business Name): REHAB TEX PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 SHENANDOAH RD
CORONA CA
92879-8509
US

IV. Provider business mailing address

647 SHENANDOAH RD
CORONA CA
92879-8509
US

V. Phone/Fax

Practice location:
  • Phone: 951-310-1130
  • Fax: 877-563-5027
Mailing address:
  • Phone: 951-310-1130
  • Fax: 877-563-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPT25778
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT25778
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License NumberPT25778
License Number StateCA

VIII. Authorized Official

Name: MRS. DONNA LEE PINEDA-FALDAS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RPT
Phone: 951-310-1130