Provider Demographics
NPI:1528600129
Name:REACTIVATE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:REACTIVATE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:442-271-8532
Mailing Address - Street 1:2451 ROCKWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4401
Mailing Address - Country:US
Mailing Address - Phone:760-890-5868
Mailing Address - Fax:760-890-5780
Practice Address - Street 1:2451 ROCKWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4401
Practice Address - Country:US
Practice Address - Phone:442-271-8532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty