MEDICARE: AGENCY REHABILITATION SERVICES

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1366577009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGENCY REHABILITATION SERVICES

Provider Business Mailing Address
First Line	:	2920 WESTMINSTER AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-5305
Country	:	US
Telephone Number	:	562-426-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 WESTMINSTER AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-5305
Country	:	US
Telephone Number	:	562-426-2051
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN SMITH
Credential	:
Telephone Number	:	562-426-2051

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	06/18/2008

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