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General NPI Number Information
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NPI Number | 1902047194
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Entity Type | Organization
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Legal Business Name | ST. MARY'S REHAB CORP
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 11037 ACACIA PKWY
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5126
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Country | US
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Telephone | 714-636-9980
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Fax | 714-721-3359
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Provider Business Mailing Address
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Address Line | 11037 ACACIA PKWY
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5126
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Country | US
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Telephone | 714-636-9980
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Fax | 714-721-3359
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Authorized Official
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Title or Position | CFO
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Name | FELICIANO OCAMPO III
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Credential | PHYSICAL THERAPIST
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Telephone | 714-626-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 24314
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License Number State | CA
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