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General NPI Number Information
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NPI Number | 1457434565
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Entity Type | Organization
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Legal Business Name | PHYSICAL REHABILITATION AND HAND CENTERS INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 4350 E RAY RD STE 117
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City | PHOENIX
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State | AZ
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Zip | 85044-6094
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Country | US
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Telephone | 480-785-1043
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Fax | 480-785-1124
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Provider Business Mailing Address
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Address Line | 540 S ANDREASEN DR SUITE C/D
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City | ESCONDIDO
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State | CA
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Zip | 92029-1917
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Country | US
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Telephone | 760-591-7750
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Fax | 760-294-9813
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. DAVID C. BOUTELLE
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Credential | PT
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Telephone | 760-591-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number |
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | AZ
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