Provider Demographics
NPI:1174860175
Name:PACIFIC COAST CARE REHAB INC.
Entity Type:Organization
Organization Name:PACIFIC COAST CARE REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:THAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-888-0656
Mailing Address - Street 1:PO BOX 12426
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5062
Mailing Address - Country:US
Mailing Address - Phone:562-888-0656
Mailing Address - Fax:
Practice Address - Street 1:4154 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-3141
Practice Address - Country:US
Practice Address - Phone:562-888-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty