Provider Demographics
NPI:1083085278
Name:CALIFORNIA REHAB & SPORTS THERAPY
Entity Type:Organization
Organization Name:CALIFORNIA REHAB & SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP RCM
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-607-9679
Mailing Address - Street 1:5962 LA PLACE CT # 150
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8807
Mailing Address - Country:US
Mailing Address - Phone:760-607-9679
Mailing Address - Fax:760-602-3273
Practice Address - Street 1:5962 LA PLACE CT # 150
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-8807
Practice Address - Country:US
Practice Address - Phone:760-607-9679
Practice Address - Fax:760-602-3273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA REHAB & SPORTS THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty