Provider Demographics
NPI:1104850197
Name:ADI REHAB, INCORPORATED
Entity Type:Organization
Organization Name:ADI REHAB, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:323-933-9060
Mailing Address - Street 1:10635 SANTA MONICA BLVD STE 165
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8306
Mailing Address - Country:US
Mailing Address - Phone:310-481-0644
Mailing Address - Fax:310-474-4034
Practice Address - Street 1:10635 SANTA MONICA BLVD STE 165
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8306
Practice Address - Country:US
Practice Address - Phone:310-481-0644
Practice Address - Fax:310-474-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14546Medicare PIN