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General NPI Number Information
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NPI Number | 1588614788
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Entity Type | Organization
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Legal Business Name | PACIFIC REHAB, INC.
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 E REDLANDS BLVD SUITE 245
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City | REDLANDS
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State | CA
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Zip | 92373-4775
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Country | US
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Telephone | 909-835-0638
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Fax | 760-416-9852
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Provider Business Mailing Address
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Address Line | PO BOX 12112
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-2112
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Country | US
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Telephone | 909-835-0638
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Fax | 760-416-9852
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS JOHANNA PAZ MAMARIL
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Credential | RPT
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Telephone | 909-835-0638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 29464
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License Number State | CA
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