MEDICARE: COMPREHENSIVE THERAPEUTIC REHABILITATION 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	174400000X	Specialist	PT 11680	CA

General Provider Information

NPI Number	:	1235266305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE THERAPEUTIC REHABILITATION INC.

Provider Business Mailing Address
First Line	:	655 S FLOWER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2805
Country	:	US
Telephone Number	:	213-430-9180
Fax Number	:	213-430-9193

Provider Business Practice Location Address
First Line	:	5301 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4038
Country	:	US
Telephone Number	:	323-887-7458
Fax Number	:	323-887-8288

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. MARIO POLANCO
Credential	:
Telephone Number	:	310-801-9550

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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