Provider Demographics
NPI:1063570653
Name:BAY REHABILITATION INC
Entity type:Organization
Organization Name:BAY REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:323-725-0711
Mailing Address - Street 1:1520 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3930
Mailing Address - Country:US
Mailing Address - Phone:323-725-0711
Mailing Address - Fax:323-725-0284
Practice Address - Street 1:1520 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3930
Practice Address - Country:US
Practice Address - Phone:323-725-0711
Practice Address - Fax:323-725-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM481AOtherMEDICARE PTAN #