Organization
CALIFORNIA REHABILITATION & SPORTS THERAPY
Active
Other names
PRN-California Rehabilitation & Sports Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE LASSON (VICE PRESIDENT)
(408) 570-0510
Entity
Organization
Contact information
Practice address
79440 CORPORATE CENTER DR, #112, LA QUINTA, CA 92253-7241
(760) 777-9701
(760) 777-9727
Mailing address
5962 LA PLACE CT, STE 170, CARLSBAD, CA 92008-8807
(800) 929-4776
(760) 931-8370
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 15311
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2195851
FIRST HEALTH
CA
01
—
ZZZ05302Z
BLUE SHIELD
CA
Enumeration date
05/17/2006
Last updated
08/22/2020
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