Provider Demographics
NPI:1316987126
Name:REHAB ALLIANCE
Entity type:Organization
Organization Name:REHAB ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-707-5555
Mailing Address - Street 1:22995 MILL CREEK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1215
Mailing Address - Country:US
Mailing Address - Phone:949-707-5555
Mailing Address - Fax:949-707-5706
Practice Address - Street 1:22995 MILL CREEK DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1215
Practice Address - Country:US
Practice Address - Phone:949-707-5555
Practice Address - Fax:949-707-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 10854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGCT000220Medicaid
CAGPT000430Medicaid
CAGSP000230Medicaid
CAW15403Medicare ID - Type UnspecifiedPT
CAGCT000220Medicaid
CAGPT000430Medicaid