Basic Information
| Provider Information | |||||||||
| NPI: | 1871545814 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALIFORNIA REHABILITATION & SPORTS THERAPY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRN PALM SPRINGS PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5962 LA PLACE CT | ||||||||
| Address2: | STE 170 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920088807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009294776 | ||||||||
| FaxNumber: | 7609318370 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S FARRELL DR | ||||||||
| Address2: | STE B202 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922627964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603273416 | ||||||||
| FaxNumber: | 7603270606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LASSON | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4085700510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 28883 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2022872 | 01 | CA | FIRST HEALTH | OTHER | ZZZ07313Z | 01 | CA | BLUE SHIELD | OTHER |