Provider Demographics
NPI:1992890388
Name:PROS IN REHAB
Entity type:Organization
Organization Name:PROS IN REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SABOO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:408-489-3846
Mailing Address - Street 1:17316 ZENA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTE SERENO
Mailing Address - State:CA
Mailing Address - Zip Code:95030
Mailing Address - Country:US
Mailing Address - Phone:498-489-3846
Mailing Address - Fax:408-399-7054
Practice Address - Street 1:17316 ZENA AVENUE
Practice Address - Street 2:
Practice Address - City:MONTE SERENO
Practice Address - State:CA
Practice Address - Zip Code:95030
Practice Address - Country:US
Practice Address - Phone:498-489-3846
Practice Address - Fax:408-399-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03780ZMedicare ID - Type UnspecifiedHEALTH CARE/REHAB SERVICE
CAOPT163580Medicare ID - Type UnspecifiedPHYSICAL THERAPIST