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General NPI Number Information
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NPI Number | 1043354665
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Entity Type | Organization
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Legal Business Name | REHAB DYNAMIC SERVICES INC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 17616 GRAYLAND AVE
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City | ARTESIA
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State | CA
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Zip | 90701-4025
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Country | US
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Telephone | 562-860-2068
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Fax | 562-809-4698
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Provider Business Mailing Address
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Address Line | 17616 GRAYLAND AVE
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City | ARTESIA
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State | CA
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Zip | 90701-4025
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Country | US
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Telephone | 562-860-2068
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Fax | 562-809-4698
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Authorized Official
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Title or Position | PRESIDENT
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Name | ZOSIMA N SOLIVEN
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Credential | RPT
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Telephone | 562-860-2068
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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 | PT19655
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License Number State | CA
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