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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |