Provider Demographics
NPI:1720485451
Name:RP REHAB AND PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RP REHAB AND PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LUNA
Authorized Official - Last Name:POBLANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-534-4568
Mailing Address - Street 1:3100 ORO DAM BLVD E
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5183
Mailing Address - Country:US
Mailing Address - Phone:530-534-4568
Mailing Address - Fax:530-534-3621
Practice Address - Street 1:3100 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5183
Practice Address - Country:US
Practice Address - Phone:530-534-4568
Practice Address - Fax:530-534-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT212270Medicaid
CA0PT212270Medicare PIN