Basic Information
| Provider Information | |||||||||
| NPI: | 1255570891 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH PACIFIC REHABILITATION SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16260 VENTURA BLVD | ||||||||
| Address2: | 600 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189861977 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15216 VANOWEN ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189861977 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2009 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8189861977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.