Provider Demographics
NPI:1144226473
Name:THE CENTER FOR PHYSICAL THERAPY AND REHABILITATION INC
Entity Type:Organization
Organization Name:THE CENTER FOR PHYSICAL THERAPY AND REHABILITATION INC
Other - Org Name:NOVACARE OUTPATIENT REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-782-1212
Mailing Address - Street 1:1090 SUNRISE AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4466
Mailing Address - Country:US
Mailing Address - Phone:916-782-1212
Mailing Address - Fax:916-773-1481
Practice Address - Street 1:435 SAINT MICHAELS DR
Practice Address - Street 2:STE A101
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7668
Practice Address - Country:US
Practice Address - Phone:505-982-8860
Practice Address - Fax:505-989-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32-6517Medicare ID - Type Unspecified