Organization
CALIFORNIA REHABILITATION & SPORTS THERAPY
Active
Other names
PRN ADVANCED PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE LASSON (VICE PRESIDENT)
(408) 570-0510
Entity
Organization
Contact information
Practice address
11276 5TH ST, #400, RANCHO CUCAMONGA, CA 91730-0921
(909) 987-1116
(909) 987-0126
Mailing address
200 NEWPORT CENTER DR, #213, NEWPORT BEACH, CA 92660-7501
(949) 644-1322
(949) 644-0316
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 14720
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212237
FIRST HEALTH
CA
01
—
ZZZ06890Z
BLUE SHIELD
CA
Enumeration date
05/17/2006
Last updated
02/22/2008
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