Healthcare Provider Details

I. General information

NPI: 1639129745
Provider Name (Legal Business Name): CALIFORNIA REHAB AND SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CARRILLO DR STE 103
LOS ANGELES CA
90048-5400
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 310-854-0529
  • Fax: 310-854-0768
Mailing address:
  • Phone: 903-486-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2401
License Number StateCA

VIII. Authorized Official

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