Provider Demographics
NPI:1053466623
Name:PREFERRED REHAB PHY THER INC
Entity Type:Organization
Organization Name:PREFERRED REHAB PHY THER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.P.T
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARU
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-790-0178
Mailing Address - Street 1:1895 MOWRY AVE
Mailing Address - Street 2:STE 118-A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1737
Mailing Address - Country:US
Mailing Address - Phone:510-790-0383
Mailing Address - Fax:510-790-1197
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:STE 118-A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1737
Practice Address - Country:US
Practice Address - Phone:510-790-0383
Practice Address - Fax:510-790-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31961ZMedicare PIN