Provider Demographics
NPI:1801508205
Name:REHABPT
Entity type:Organization
Organization Name:REHABPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:EVERWINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:559-269-2561
Mailing Address - Street 1:883 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3337
Mailing Address - Country:US
Mailing Address - Phone:559-269-2561
Mailing Address - Fax:
Practice Address - Street 1:1810 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2766
Practice Address - Country:US
Practice Address - Phone:559-269-2561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty