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Organization
INNOVATIVE SENIOR REHABILITATION SERVICES INC.
Active
Organization
INNOVATIVE SENIOR REHABILITATION SERVICES INC.
Active
Other names
Innovative Senior Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOY HADLEY (VP CFO)
(916) 690-0757
Entity
Organization
Contact information
Practice address
2220 W KETTLEMAN LN, LODI, CA 95242-4347
(209) 365-6764
(209) 365-6764
Mailing address
222 W PINE ST, LODI, CA 95240-2020
(209) 368-1009
(209) 368-1024
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH1035
RAILROAD MEDICARE PTAN
CA
Enumeration date
12/15/2006
Last updated
07/10/2011
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