MEDICARE: CALIFORNIA REHAB AND SPORTS THERAPY

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
2	225XH1200X	Hand Occupational Therapist	OT 2401	CA

General Provider Information

NPI Number	:	1639129745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA REHAB AND SPORTS THERAPY

Provider Business Mailing Address
First Line	:	2035 CORTE DEL NOGAL STE 200
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1445
Country	:	US
Telephone Number	:	903-486-6025
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 CARRILLO DR STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5400
Country	:	US
Telephone Number	:	310-854-0529
Fax Number	:	310-854-0768

Authorized Official
Title or Position	:	COO
Name	:	ROBERT PACE
Credential	:
Telephone Number	:	213-804-1712

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/14/2019

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Directions to “CALIFORNIA REHAB AND SPORTS THERAPY ” Practice Location

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