=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194312538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REKINECTED PHYSICAL THERAPY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2020
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3141 TIGER RUN CT STE 114
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92010-6706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-585-2178
-----------------------------------------------------
Fax | 833-409-0654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3141 TIGER RUN CT STE 114
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92010-6706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-331-8111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL/PARTNER/OWNER
-----------------------------------------------------
Name | MS. BRITTANY REVELL
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 760-331-8111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------