Provider Demographics
NPI:1902126162
Name:SOUTHWEST REHAB SOLUTIONS
Entity Type:Organization
Organization Name:SOUTHWEST REHAB SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB
Authorized Official - Prefix:MS
Authorized Official - First Name:LUDE
Authorized Official - Middle Name:REGINE
Authorized Official - Last Name:RICARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-621-9215
Mailing Address - Street 1:4217 OLIVER CT
Mailing Address - Street 2:6
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3955
Mailing Address - Country:US
Mailing Address - Phone:760-791-6498
Mailing Address - Fax:
Practice Address - Street 1:1463 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4749
Practice Address - Country:US
Practice Address - Phone:760-791-6498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty