Provider Demographics
NPI:1518601012
Name:FOREVER YOUNG REHABILITATION LLC
Entity Type:Organization
Organization Name:FOREVER YOUNG REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-272-3325
Mailing Address - Street 1:1600 W COAST HWY STE E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5000
Mailing Address - Country:US
Mailing Address - Phone:949-272-3325
Mailing Address - Fax:949-333-2962
Practice Address - Street 1:1600 W COAST HWY STE E
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5000
Practice Address - Country:US
Practice Address - Phone:949-272-3325
Practice Address - Fax:949-333-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty