Healthcare Provider Details

I. General information

NPI: 1134216294
Provider Name (Legal Business Name): REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 03/17/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 RUFFIN RD SUITE F
SAN DIEGO CA
92123-1830
US

IV. Provider business mailing address

3959 RUFFIN RD STE J
SAN DIEGO CA
92123-1830
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-5570
  • Fax: 858-279-5303
Mailing address:
  • Phone: 858-279-5570
  • Fax: 858-279-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24080
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT26678
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRYAN S HILL
Title or Position: CEO & PRESIDENT
Credential: PT
Phone: 858-279-5570