Healthcare Provider Details

I. General information

NPI: 1629137526
Provider Name (Legal Business Name): CENTER FOR INDEPENDENT REHABILITATIVE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 KETTLEMAN LANE SUITE A
LODI CA
95242-9287
US

IV. Provider business mailing address

693 HI TECH PARKWAY
OAKDALE CA
95361
US

V. Phone/Fax

Practice location:
  • Phone: 209-333-1148
  • Fax: 209-333-0624
Mailing address:
  • Phone: 209-845-8231
  • Fax: 209-845-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDIE G ROGERS
Title or Position: PRESIDENT
Credential: CPO
Phone: 209-845-8231