MEDICARE: CRS PHYSICAL THERAPY 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	225100000X	Physical Therapist	PT20075	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	810098482	OTHER	CA	PRIVATE HEALTHCARE SYSTEM
2	361238600	OTHER	CA	AFFILIATED COMP SERVICES
3	CA25980605	OTHER	CA	PREFERRED THERAPY PROVDRS
4	ZZZ61556Z	OTHER	CA	BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1265478358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRS PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	4501 MISSION BAY DRIVE
Second Line	:	SUITE 3K
City	:	SAN DIEGO
State	:	CA
Zip	:	92109
Country	:	US
Telephone Number	:	858-866-0340
Fax Number	:	858-866-0342

Provider Business Practice Location Address
First Line	:	4501 MISSION BAY DR
Second Line	:	SUITE 3K
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4923
Country	:	US
Telephone Number	:	858-866-0340
Fax Number	:	858-866-0342

Authorized Official
Title or Position	:	OWNER /OPERATOR, PHYSICAL THERAPIST
Name	:	MR. FARSHID FARAJZADEH
Credential	:	M.S.P.T
Telephone Number	:	858-866-0340

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/05/2010

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