Provider Demographics
NPI:1902047194
Name:ST. MARY'S REHAB CORP
Entity Type:Organization
Organization Name:ST. MARY'S REHAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FELICIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:OCAMPO
Authorized Official - Suffix:III
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:714-626-9980
Mailing Address - Street 1:11037 ACACIA PKWY
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5126
Mailing Address - Country:US
Mailing Address - Phone:714-636-9980
Mailing Address - Fax:714-721-3359
Practice Address - Street 1:11037 ACACIA PKWY
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5126
Practice Address - Country:US
Practice Address - Phone:714-636-9980
Practice Address - Fax:714-721-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty