Provider Demographics
NPI:1164590717
Name:INNOVATIVE REHAB. INC
Entity Type:Organization
Organization Name:INNOVATIVE REHAB. INC
Other - Org Name:INNOVATIVE WELLNESS DBA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, PHD
Authorized Official - Phone:562-965-1452
Mailing Address - Street 1:15161 E. RIVIERA LANE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638
Mailing Address - Country:US
Mailing Address - Phone:562-965-1452
Mailing Address - Fax:714-690-3951
Practice Address - Street 1:506 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2904
Practice Address - Country:US
Practice Address - Phone:213-413-3038
Practice Address - Fax:213-484-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18210Medicare UPIN
CAWPT26577BMedicare UPIN