Basic Information
| Provider Information | |||||||||
| NPI: | 1013954940 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RPM REHAB INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAUER PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 FRANKLIN RD STE 135A-102 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370273280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602562800 | ||||||||
| FaxNumber: | 7602562809 | ||||||||
| Practice Location | |||||||||
| Address1: | 27071 CABOT RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926537025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495887278 | ||||||||
| FaxNumber: | 9495887331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | HAWES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO AND PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6153080994 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RPM REHAB INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.