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General NPI Number Information
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NPI Number | 1962568493
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Entity Type | Organization
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Legal Business Name | PACIFIC THERAPY AND REHAB, INC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 39159 PASEO PADRE PKWY SUITE 111
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City | FREMONT
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State | CA
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Zip | 94538-1608
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Country | US
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Telephone | 510-505-9800
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Fax | 510-505-9880
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Provider Business Mailing Address
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Address Line | PO BOX 610638
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City | SAN JOSE
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State | CA
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Zip | 95161-0638
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Country | US
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Telephone | 408-832-9656
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Fax | 510-505-9880
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | ROBERT CHAN
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Credential |
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Telephone | 408-832-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OT5979
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License Number State | CA
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