=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417626284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABMEUSA PHYSICAL THERAPY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2021
-----------------------------------------------------
Last Update Date | 09/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3355 COWELL RD
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94518-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-876-9872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3355 COWELL RD
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94518-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-876-9872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. JAYSON BRYANT MERRILL
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 925-876-9872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------