Provider Demographics
NPI:1407162241
Name:INNOVATION PHYSICAL THERAPY AND REHAB CENTER, INC.
Entity Type:Organization
Organization Name:INNOVATION PHYSICAL THERAPY AND REHAB CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEFF
Authorized Official - Middle Name:D
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:714-496-1459
Mailing Address - Street 1:8227 SANTA INEZ WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3158
Mailing Address - Country:US
Mailing Address - Phone:714-496-1459
Mailing Address - Fax:
Practice Address - Street 1:8227 SANTA INEZ WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3158
Practice Address - Country:US
Practice Address - Phone:714-496-1459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty