MEDICARE: VIGOR REHAB SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist

General Provider Information

NPI Number	:	1063976751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIGOR REHAB SERVICES INC.

Provider Business Mailing Address
First Line	:	916 SILVER SPUR RD STE 110
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 SILVER SPUR RD STE 110
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3826
Country	:	US
Telephone Number	:	310-265-1001
Fax Number	:

Authorized Official
Title or Position	:	OTR/L
Name	:	RIZA BERNAL
Credential	:
Telephone Number	:	310-265-1001

Provider Enumeration Date	:	01/26/2019
Last Update Date	:	01/26/2019

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