1568568590 NPI number — DEL RIO PHYSICAL THERAPY AND REHABILITATION CENTER INC

Table of content: (NPI 1568568590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568568590 NPI number — DEL RIO PHYSICAL THERAPY AND REHABILITATION CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEL RIO PHYSICAL THERAPY AND REHABILITATION CENTER 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:
Provider Other Organization Name Type Code:
6
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:
1568568590
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:
710 N BEDELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEL RIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78840-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-775-9118
Provider Business Mailing Address Fax Number:
830-775-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 N BEDELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL RIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78840-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-775-9118
Provider Business Practice Location Address Fax Number:
830-775-9229
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARMAN
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
SHAWN
Authorized Official Title or Position:
ADMINISTRATOR/CO OWNER
Authorized Official Telephone Number:
830-775-9118

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QP2000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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