Provider Demographics
NPI:1134216294
Name:REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:REHAB UNITED SPORTS MEDICINE & PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:858-279-5570
Mailing Address - Street 1:3959 RUFFIN RD STE J
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1830
Mailing Address - Country:US
Mailing Address - Phone:858-279-5570
Mailing Address - Fax:858-279-5303
Practice Address - Street 1:3959 RUFFIN RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1830
Practice Address - Country:US
Practice Address - Phone:858-279-5570
Practice Address - Fax:858-279-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT266782251P0200X
225X00000X, 235Z00000X
CAPT24080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA601912800OtherACS US DEPT OF LABOR-DOL
CA76332OtherUCSD NETWORK
CABLUE SHIELDOtherZZZ08081Z
CA2196748OtherFIRST HEALTH PIN
CA643644OtherCONNECTICARE
CAGPT001640Medicaid
CA0007920691OtherAETNA
CA8731210OtherHEALTH NET
CA5514891OtherCCN PIN
CA573373OtherCIGNA
CAGPT001640Medicaid
CA601912800OtherACS US DEPT OF LABOR-DOL
CA=========OtherPTPN NETWORK
CAW16693Medicare ID - Type Unspecified