1972631760 NPI number — CABATHERAPY SERVICES

Table of content: (NPI 1972631760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972631760 NPI number — CABATHERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CABATHERAPY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REHABILITATION SERVICES OF BAYTOWN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972631760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7287
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77522-7205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-424-7557
Provider Business Mailing Address Fax Number:
281-424-7567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3818 DECKER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77520-1662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-424-7557
Provider Business Practice Location Address Fax Number:
281-424-7567
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TOUPS
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
281-424-7557

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  652560001 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0003KX . This is a "BLUE CROSS BLUE SHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 686248 . This is a "UNITEDHEALTHCARE ACN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7698435 . This is a "AETNA ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6362783 . This is a "CIGNA ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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