Provider Demographics
NPI:1659580322
Name:PHYSICAL REHABILITATION & HAND CENTERS INC
Entity Type:Organization
Organization Name:PHYSICAL REHABILITATION & HAND CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOUTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:760-591-7750
Mailing Address - Street 1:600 S ANDREASEN DR
Mailing Address - Street 2:STE C/D
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-1917
Mailing Address - Country:US
Mailing Address - Phone:760-591-7750
Mailing Address - Fax:760-294-9813
Practice Address - Street 1:600 S ANDREASEN DR
Practice Address - Street 2:STE C/D
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-1917
Practice Address - Country:US
Practice Address - Phone:760-591-7750
Practice Address - Fax:760-294-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70926OtherMEDICARE