Provider Demographics
NPI:1245251511
Name:WILCOX PHYSICAL REHABILITATION CENTER
Entity type:Organization
Organization Name:WILCOX PHYSICAL REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDINA
Authorized Official - Middle Name:GERTRUDA
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-535-7700
Mailing Address - Street 1:760 N EUCLID ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4133
Mailing Address - Country:US
Mailing Address - Phone:714-535-7700
Mailing Address - Fax:714-535-5445
Practice Address - Street 1:760 N EUCLID ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4133
Practice Address - Country:US
Practice Address - Phone:714-535-7700
Practice Address - Fax:714-535-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14651Medicare ID - Type Unspecified