Providence Rehab Group, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROVIDENCE REHAB GROUP, INC.

Practice address

3230 Carlson Blvd
El Cerrito, CA 94530-3907

Phone

(510) 525-3212

NPI assigned

Aug 18, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Ruel Warriner Abiad, OT

Title

Ceo

Phone

(415) 225-0126

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1891307112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5215",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949485215",
            "telephone_number": "415-225-0126",
            "fax_number": "415-223-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3230 CARLSON BLVD",
            "city": "EL CERRITO",
            "state": "CA",
            "postal_code": "945303907",
            "telephone_number": "510-525-3212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 Cutting Blvd",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "CA",
            "postal_code": "948042662",
            "country_code": "US",
            "telephone_number": "510-233-8513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE REHAB GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "ABIAD",
        "authorized_official_first_name": "RUEL",
        "authorized_official_middle_name": "WARRINER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-225-0126",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.