Provider Demographics
NPI:1144639980
Name:NEURO REHAB CONNECTION
Entity type:Organization
Organization Name:NEURO REHAB CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:480-789-2980
Mailing Address - Street 1:33175 TEMECULA PKWY # A-124
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-7310
Mailing Address - Country:US
Mailing Address - Phone:951-595-3268
Mailing Address - Fax:951-266-5759
Practice Address - Street 1:31309 TEMECULA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6826
Practice Address - Country:US
Practice Address - Phone:951-595-3268
Practice Address - Fax:951-266-5759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT13729261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA137889OtherMEDICARE PTAN