Prehab LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

PREHAB LLC

Practice address

10405 SD MSSN Rd Ste 103105
San Diego, CA 92108-2102

Phone

(646) 403-6388

NPI assigned

Oct 5, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alex Gometz, PTNPI 1457441370

Title

Owner

Phone

(212) 717-8330

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alex Gometz, DPT

  • Orthopedic Physical Therapist
  • New York, NY
  • NPI 1457441370
  NPD Authorized official
• Bree E Nishibun, DPT

  • Physical Therapist
  • San Diego, CA
  • NPI 1699373902
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1104423052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10405 SD MSSN RD STE 103105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082102",
            "telephone_number": "619-369-9442",
            "fax_number": "213-336-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10405 SD MSSN RD STE 103105",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082102",
            "telephone_number": "646-403-6388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-05",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A",
        "authorized_official_last_name": "GOMETZ",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-717-8330",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in San Diego, CA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.