1174692883 NPI number — RESTHAB INC.

Table of content: (NPI 1174692883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174692883 NPI number — RESTHAB INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTHAB INC.
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:
SULPHUR SPRINGS PHYSICAL THERAPY
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:
1174692883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULPHUR SPRINGS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75483-0029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-885-9906
Provider Business Mailing Address Fax Number:
903-438-9636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 INDUSTRIAL DR E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULPHUR SPRINGS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75482-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-885-9906
Provider Business Practice Location Address Fax Number:
903-438-9636
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IRBY
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
ADMINISTRATORCOOWNER
Authorized Official Telephone Number:
903-885-9906

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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: 0051JB . This is a "BCBS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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