Healthcare Provider Details

I. General information

NPI: 1750332490
Provider Name (Legal Business Name): CALIFORNIA REHABILITATION & SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S HARBOR BLVD STE B
LA HABRA CA
90631-7577
US

IV. Provider business mailing address

200 NEWPORT CENTER DR #213
NEWPORT BEACH CA
92660-7501
US

V. Phone/Fax

Practice location:
  • Phone: 714-441-0763
  • Fax: 714-441-0883
Mailing address:
  • Phone: 949-644-1322
  • Fax: 949-644-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 12558
License Number StateCA

VIII. Authorized Official

Name: ANNE LASSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 408-570-0510