MEDICARE: REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	PT26678	CA
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	225100000X	Physical Therapist	PT24080	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601912800	OTHER	CA	ACS US DEPT OF LABOR-DOL
2	76332	OTHER	CA	UCSD NETWORK
3	BLUE SHIELD	OTHER	CA	ZZZ08081Z
4	2196748	OTHER	CA	FIRST HEALTH PIN
5	643644	OTHER	CA	CONNECTICARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0007920691	OTHER	CA	AETNA
8	8731210	OTHER	CA	HEALTH NET
9	5514891	OTHER	CA	CCN PIN
10	573373	OTHER	CA	CIGNA

NPI Number	:	1134216294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	3959 RUFFIN RD STE J
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1830
Country	:	US
Telephone Number	:	858-279-5570
Fax Number	:	858-279-5303

Provider Business Practice Location Address
First Line	:	3959 RUFFIN RD
Second Line	:	SUITE F
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1830
Country	:	US
Telephone Number	:	858-279-5570
Fax Number	:	858-279-5303

Authorized Official
Title or Position	:	CEO & PRESIDENT
Name	:	BRYAN S HILL
Credential	:	PT
Telephone Number	:	858-279-5570

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	03/17/2021