Healthcare Provider Details

I. General information

NPI: 1114978830
Provider Name (Legal Business Name): CALIFORNIA REHABILITATION & SPORTS THERAPY A CALIFORNIA PHYSICAL THER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E 4TH ST #170
SANTA ANA CA
92705-3814
US

IV. Provider business mailing address

2600 DALLAS PKWY STE 290
FRISCO TX
75034-7493
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-3977
  • Fax: 714-558-0308
Mailing address:
  • Phone: 945-050-0010
  • Fax: 949-644-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 20582
License Number StateCA

VIII. Authorized Official

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