Provider Demographics
NPI:1023071099
Name:MEDICAL REHAB SUPPLY, INC
Entity type:Organization
Organization Name:MEDICAL REHAB SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETTICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-285-1135
Mailing Address - Street 1:3636 CAMINO DEL RIO N STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1709
Mailing Address - Country:US
Mailing Address - Phone:844-285-1135
Mailing Address - Fax:800-693-5073
Practice Address - Street 1:3636 CAMINO DEL RIO N STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1709
Practice Address - Country:US
Practice Address - Phone:844-285-1135
Practice Address - Fax:800-693-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0013103332B00000X
TX0068028332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010367301Medicaid
TX010367301Medicaid