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General NPI Number Information
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NPI Number | 1033460589
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Entity Type | Organization
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Legal Business Name | REHAB AND REVIVE PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 3002 DOW AVE STE 506
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City | TUSTIN
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State | CA
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Zip | 92780-7237
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Country | US
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Telephone | 714-900-3880
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Fax | 714-731-0932
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Provider Business Mailing Address
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Address Line | 3002 DOW AVE STE 506
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City | TUSTIN
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State | CA
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Zip | 92780-7237
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Country | US
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Telephone | 714-900-3880
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Fax | 714-731-0932
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JUSTIN LIN
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Credential | DPT
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Telephone | 714-900-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 35795
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License Number State | CA
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