Provider Demographics
NPI:1740408483
Name:EINHORN MANDAS & BRADLEY REHAB INC
Entity Type:Organization
Organization Name:EINHORN MANDAS & BRADLEY REHAB INC
Other - Org Name:LOS ALAMITOS ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:EINHORN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:562-431-6004
Mailing Address - Street 1:5152 KATELLA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2843
Mailing Address - Country:US
Mailing Address - Phone:562-431-6004
Mailing Address - Fax:562-431-9854
Practice Address - Street 1:5152 KATELLA AVE STE 106
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2843
Practice Address - Country:US
Practice Address - Phone:562-431-6004
Practice Address - Fax:562-431-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF9194OtherRAILROAD MEDICARE
CA126026700OtherDEPT LABOR PROVIDER #
CAW15187Medicare PIN
CAW15187AMedicare PIN