Provider Demographics
NPI:1043405434
Name:BERNADETTE WOODS
Entity Type:Organization
Organization Name:BERNADETTE WOODS
Other - Org Name:REJUVENATION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-275-5044
Mailing Address - Street 1:6529 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3122
Mailing Address - Country:US
Mailing Address - Phone:951-275-5044
Mailing Address - Fax:951-275-5045
Practice Address - Street 1:6529 RIVERSIDE AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3122
Practice Address - Country:US
Practice Address - Phone:951-275-5044
Practice Address - Fax:951-275-5045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL00129777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT141590Medicare PIN