Provider Demographics
NPI:1386935492
Name:REHAB EXCELLENCE
Entity type:Organization
Organization Name:REHAB EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:SON
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD
Authorized Official - Phone:714-608-1778
Mailing Address - Street 1:9441 SHADWELL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7213
Mailing Address - Country:US
Mailing Address - Phone:714-608-1778
Mailing Address - Fax:714-965-8812
Practice Address - Street 1:9441 SHADWELL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7213
Practice Address - Country:US
Practice Address - Phone:714-608-1778
Practice Address - Fax:714-965-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 19284OtherPHYSICAL THERAPY BOARD OF CALIFORNIA