Provider Demographics
NPI:1154922425
Name:REBUILD THERAPY SERVICES LLC
Entity type:Organization
Organization Name:REBUILD THERAPY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TAYAG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-230-3752
Mailing Address - Street 1:1706 SILVERBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6422
Mailing Address - Country:US
Mailing Address - Phone:760-230-3752
Mailing Address - Fax:
Practice Address - Street 1:1706 SILVERBERRY WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6422
Practice Address - Country:US
Practice Address - Phone:760-230-3752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty