Provider Demographics
NPI:1043354665
Name:REHAB DYNAMIC SERVICES INC
Entity Type:Organization
Organization Name:REHAB DYNAMIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZOSIMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SOLIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:562-860-2068
Mailing Address - Street 1:17616 GRAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4025
Mailing Address - Country:US
Mailing Address - Phone:562-860-2068
Mailing Address - Fax:562-809-4698
Practice Address - Street 1:17616 GRAYLAND AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4025
Practice Address - Country:US
Practice Address - Phone:562-860-2068
Practice Address - Fax:562-809-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19028Medicare PIN
CAWPT19655AMedicare ID - Type UnspecifiedPPIN