MEDICARE: PREMIER 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

General Provider Information

NPI Number	:	1285621029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	6635 DUBLIN BLVD
Second Line	:	SUITE E
City	:	DUBLIN
State	:	CA
Zip	:	94568-3000
Country	:	US
Telephone Number	:	925-803-0530
Fax Number	:	925-803-2047

Provider Business Practice Location Address
First Line	:	6635 DUBLIN BLVD
Second Line	:	SUITE E
City	:	DUBLIN
State	:	CA
Zip	:	94568-3000
Country	:	US
Telephone Number	:	925-803-0530
Fax Number	:	925-803-2047

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MITZI L HARRISON
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	925-245-0100

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	05/09/2008

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