Provider Demographics
NPI:1184758161
Name:GOOD REHAB PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:GOOD REHAB PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YOU
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:213-382-0088
Mailing Address - Street 1:2727 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2699
Mailing Address - Country:US
Mailing Address - Phone:213-382-0088
Mailing Address - Fax:213-380-2038
Practice Address - Street 1:2727 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2699
Practice Address - Country:US
Practice Address - Phone:213-382-0088
Practice Address - Fax:213-380-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW18556261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18556Medicare ID - Type Unspecified