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General NPI Number Information
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NPI Number | 1023196045
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Entity Type | Organization
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Legal Business Name | USA REHAB AND WELLNESS CTR LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13428 MAXELLA AVE STE 505
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5620
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Country | US
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Telephone | 310-822-3770
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Fax | 310-822-3770
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Provider Business Mailing Address
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Address Line | 13428 MAXELLA AVE STE 505
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5620
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Country | US
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Telephone | 310-822-3770
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Fax | 310-822-3770
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. FELICIA THOMAS
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Credential | BILLING SERVICE OWNE
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Telephone | 858-504-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 20A81676
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License Number State | CA
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