| Pacific Rehabilitation | |
|
5000 Overland Ave, #4, Culver City, CA 90230 | |
| (310) 836-7650 | |
| (310) 836-7651 |
| Full Name | Pacific Rehabilitation |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 5000 Overland Ave, Culver City, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609058445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 20709 (California) | Primary |
| Provider Name | Dacosta Alonzo Collymore |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568497659 PECOS PAC ID: 0042276776 Enrollment ID: I20041206000592 |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Rehabilitation 5000 Overland Ave, #4, Culver City, CA 90230 Ph: (310) 836-7650 | Pacific Rehabilitation 5000 Overland Ave, #4, Culver City, CA 90230 Ph: (310) 836-7650 |
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