Provider Demographics
NPI:1700252962
Name:SCOLIOSIS REHAB, INC.-CA
Entity Type:Organization
Organization Name:SCOLIOSIS REHAB, INC.-CA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHERRATT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-785-1774
Mailing Address - Street 1:3162 NEWBERRY DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1500
Mailing Address - Country:US
Mailing Address - Phone:408-785-1774
Mailing Address - Fax:408-470-7733
Practice Address - Street 1:3162 NEWBERRY DR
Practice Address - Street 2:SUITE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1500
Practice Address - Country:US
Practice Address - Phone:408-785-1774
Practice Address - Fax:408-470-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty