Provider Demographics
NPI:1790772531
Name:PREMIER REHABILITATION, INC
Entity Type:Organization
Organization Name:PREMIER REHABILITATION, INC
Other - Org Name:PREMIER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:925-245-0100
Mailing Address - Street 1:339 STEALTH CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-9303
Mailing Address - Country:US
Mailing Address - Phone:925-245-0100
Mailing Address - Fax:925-245-0300
Practice Address - Street 1:11700 DUBLIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2822
Practice Address - Country:US
Practice Address - Phone:925-803-0530
Practice Address - Fax:925-803-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25322ZMedicare ID - Type UnspecifiedMEDICARE NUMBER