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General NPI Number Information
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NPI Number | 1952338238
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Entity Type | Organization
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Legal Business Name | CREATIVE REHAB TECHNOLOGY SERVICES, INC.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 320 TROUSDALE DR UNIT B
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City | CHULA VISTA
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State | CA
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Zip | 91910-1069
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Country | US
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Telephone | 619-616-2649
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Fax | 619-427-0500
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Provider Business Mailing Address
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Address Line | 320 TROUSDALE DR UNIT B
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City | CHULA VISTA
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State | CA
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Zip | 91910-1069
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Country | US
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Telephone | 619-616-2649
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Fax | 877-220-8272
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. PAUL STEPHEN PROTZMAN
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Credential |
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Telephone | 619-616-2649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 103561
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License Number State | CA
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