Provider Demographics
NPI:1184803389
Name:INNOVATIVE REHAB SERVICE, INC
Entity type:Organization
Organization Name:INNOVATIVE REHAB SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-484-1280
Mailing Address - Street 1:1125 N MAGNOLIA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 N MAGNOLIA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2638
Practice Address - Country:US
Practice Address - Phone:714-484-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty