Healthcare Provider Details

I. General information

NPI: 1780662718
Provider Name (Legal Business Name): SOCAL REHAB ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 10TH ST
RIVERSIDE CA
92501-3522
US

IV. Provider business mailing address

3908 10TH ST
RIVERSIDE CA
92501-3522
US

V. Phone/Fax

Practice location:
  • Phone: 951-274-7744
  • Fax: 951-274-7754
Mailing address:
  • Phone: 951-274-7744
  • Fax: 951-274-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4384172S
License Number StateCA

VIII. Authorized Official

Name: TREVYN LOY DESPAIN
Title or Position: OWNER PHYSICAL THERAPIST
Credential: PT
Phone: 951-274-7744