Provider Demographics
NPI:1497920441
Name:UNIVERSAL REHABILITATION, INC.
Entity Type:Organization
Organization Name:UNIVERSAL REHABILITATION, INC.
Other - Org Name:ALPHA REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUNCAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:213-382-8484
Mailing Address - Street 1:440 SHATTO PL
Mailing Address - Street 2:2ND FLOOR SUITE 209
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1765
Mailing Address - Country:US
Mailing Address - Phone:213-382-8484
Mailing Address - Fax:866-438-5974
Practice Address - Street 1:440 SHATTO PL
Practice Address - Street 2:2ND FLOOR SUITE 209
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1765
Practice Address - Country:US
Practice Address - Phone:213-382-8484
Practice Address - Fax:866-438-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT21950BMedicare PIN