Healthcare Provider Details

I. General information

NPI: 1831815760
Provider Name (Legal Business Name): CALIFORNIA REHAB AND SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44501 16TH ST W STE 107
LANCASTER CA
93534-2884
US

IV. Provider business mailing address

2035 CORTE DEL NOGAL STE 200
CARLSBAD CA
92011-1445
US

V. Phone/Fax

Practice location:
  • Phone: 661-974-7033
  • Fax: 661-974-7022
Mailing address:
  • Phone: 760-931-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PACE
Title or Position: COO
Credential:
Phone: 213-804-1712