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General NPI Number Information
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NPI Number | 1174860175
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Entity Type | Organization
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Legal Business Name | PACIFIC COAST CARE REHAB INC.
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 4154 WOODRUFF AVE
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City | LAKEWOOD
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State | CA
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Zip | 90713-3141
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Country | US
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Telephone | 562-888-0656
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12426
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-5062
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Country | US
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Telephone | 562-888-0656
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PHILIP THAMES
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Credential |
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Telephone | 562-888-0656
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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 | PT6772
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License Number State | CA
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