Provider Demographics
NPI:1558559377
Name:DESERT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DESERT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:CLAUDINE
Authorized Official - Last Name:REHE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, DPT, ATC
Authorized Official - Phone:909-556-7671
Mailing Address - Street 1:161 OLD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-3211
Mailing Address - Country:US
Mailing Address - Phone:760-341-3846
Mailing Address - Fax:760-341-3924
Practice Address - Street 1:161 OLD RANCH RD
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-3211
Practice Address - Country:US
Practice Address - Phone:760-341-3846
Practice Address - Fax:760-341-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ50270YOtherBLUE SHIELD OF CALIFORNIA
CAZZZ05800ZMedicare PIN