Healthcare Provider Details

I. General information

NPI: 1790772531
Provider Name (Legal Business Name): PREMIER REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 DUBLIN BLVD SUITE 100
DUBLIN CA
94568-2822
US

IV. Provider business mailing address

339 STEALTH CT
LIVERMORE CA
94551-9303
US

V. Phone/Fax

Practice location:
  • Phone: 925-803-0530
  • Fax: 925-803-2047
Mailing address:
  • Phone: 925-245-0100
  • Fax: 925-245-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. MITZI L HARRISON
Title or Position: OWNER
Credential: PHYSICAL THERAPIST
Phone: 925-245-0100