Provider Demographics
NPI:1902935075
Name:OMNI REHAB & THERAPY CENTER
Entity Type:Organization
Organization Name:OMNI REHAB & THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:SHAFIEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPTS
Authorized Official - Phone:909-370-0611
Mailing Address - Street 1:1642 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4605
Mailing Address - Country:US
Mailing Address - Phone:909-370-0611
Mailing Address - Fax:909-370-0612
Practice Address - Street 1:1642 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4605
Practice Address - Country:US
Practice Address - Phone:909-370-0611
Practice Address - Fax:909-370-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17474208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty