=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730279050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLOBAL REHAB SOLUTION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1445 N SUNRISE WAY SUITE 103
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92262-3700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-416-9842
-----------------------------------------------------
Fax | 760-416-9852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 12112
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92423-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-835-0638
-----------------------------------------------------
Fax | 760-416-9852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRESIDENT
-----------------------------------------------------
Name | MISS JOHANNA MAMARIL
-----------------------------------------------------
Credential | RPT
-----------------------------------------------------
Telephone | 909-835-0638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 29464
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------