Provider Demographics
NPI:1811953490
Name:S.W. REHABILITATION ASSOCIATES, LTD
Entity type:Organization
Organization Name:S.W. REHABILITATION ASSOCIATES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/STAFF THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-344-1656
Mailing Address - Street 1:2281 W 24TH STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6197
Mailing Address - Country:US
Mailing Address - Phone:928-344-1656
Mailing Address - Fax:928-344-5072
Practice Address - Street 1:2281 W 24TH STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6197
Practice Address - Country:US
Practice Address - Phone:928-344-1656
Practice Address - Fax:928-344-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0293620OtherBLUE CROSS OF AZ
AZAZ0293620OtherBLUE CROSS OF AZ
AZZ28377Medicare UPIN