Healthcare Provider Details

I. General information

NPI: 1720029176
Provider Name (Legal Business Name): SOUTHWEST REHAB SPECIALIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 ASHTON CT
IMPERIAL CA
92251-8803
US

IV. Provider business mailing address

2300 ASHTON CT
IMPERIAL CA
92251-8803
US

V. Phone/Fax

Practice location:
  • Phone: 760-455-3306
  • Fax: 760-344-8240
Mailing address:
  • Phone: 760-455-3306
  • Fax: 760-344-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberW19446
License Number StateCA

VIII. Authorized Official

Name: ROMULO GARCIA
Title or Position: OWNER
Credential:
Phone: 760-455-3306