Provider Demographics
NPI:1982783437
Name:PACIFIC ORTHO & SPORTS REHAB
Entity Type:Organization
Organization Name:PACIFIC ORTHO & SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-803-0224
Mailing Address - Street 1:1260 B ST
Mailing Address - Street 2:#250
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2955
Mailing Address - Country:US
Mailing Address - Phone:510-247-9971
Mailing Address - Fax:510-247-9974
Practice Address - Street 1:1260 B ST
Practice Address - Street 2:#250
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2955
Practice Address - Country:US
Practice Address - Phone:510-247-9971
Practice Address - Fax:510-247-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19765ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #