Healthcare Provider Details

I. General information

NPI: 1255570891
Provider Name (Legal Business Name): SOUTH PACIFIC REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15216 VANOWEN ST
VAN NUYS CA
91405-3601
US

IV. Provider business mailing address

16260 VENTURA BLVD 600
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1977
  • Fax:
Mailing address:
  • Phone: 818-986-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB COHEN
Title or Position: PRESIDENT
Credential: P.T.
Phone: 818-986-1977