Provider Demographics
NPI:1447237953
Name:CYPRESS REHAB GROUP
Entity Type:Organization
Organization Name:CYPRESS REHAB GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:JUHL
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:909-981-7251
Mailing Address - Street 1:112 HARVARD AVE
Mailing Address - Street 2:#260
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4716
Mailing Address - Country:US
Mailing Address - Phone:909-981-7251
Mailing Address - Fax:909-982-1257
Practice Address - Street 1:112 HARVARD AVE
Practice Address - Street 2:#260
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4716
Practice Address - Country:US
Practice Address - Phone:909-981-7251
Practice Address - Fax:909-982-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18708Medicare ID - Type UnspecifiedCALIFORNIA SOUTH
CAZZZ014832Medicare ID - Type UnspecifiedCALIFORNIA NORTH