Provider Demographics
NPI:1225148240
Name:FELIX R CANOUT REHABILITATION SERVICES, INC
Entity Type:Organization
Organization Name:FELIX R CANOUT REHABILITATION SERVICES, INC
Other - Org Name:MID WILSHIRE REHABILITATION CENTER;WILSHIRE CENTER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CANOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:213-481-1515
Mailing Address - Street 1:3638 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4118
Mailing Address - Country:US
Mailing Address - Phone:213-481-1515
Mailing Address - Fax:213-481-1518
Practice Address - Street 1:1200 WILSHIRE BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1919
Practice Address - Country:US
Practice Address - Phone:213-481-1515
Practice Address - Fax:213-481-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056825Medicare ID - Type UnspecifiedPROVIDER NUMBER