Provider Demographics
NPI:1104383074
Name:HAND REHAB PROS ANTELOPE VALLEY
Entity type:Organization
Organization Name:HAND REHAB PROS ANTELOPE VALLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUEYRU
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:661-414-4031
Mailing Address - Street 1:38925 TRADE CENTER DR UNIT H
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3655
Mailing Address - Country:US
Mailing Address - Phone:661-414-4031
Mailing Address - Fax:
Practice Address - Street 1:38925 TRADE CENTER DR UNIT H
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3655
Practice Address - Country:US
Practice Address - Phone:661-414-4031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty