Healthcare Provider Details

I. General information

NPI: 1114979119
Provider Name (Legal Business Name): CALIFORNIA REHABILITATION & SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79440 CORPORATE CENTER DR #112
LA QUINTA CA
92253-7241
US

IV. Provider business mailing address

5962 LA PLACE CT STE 170
CARLSBAD CA
92008-8807
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-9701
  • Fax: 760-777-9727
Mailing address:
  • Phone: 800-929-4776
  • Fax: 760-931-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 15311
License Number StateCA

VIII. Authorized Official

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