Provider Demographics
NPI:1053641910
Name:LAREDO AUTISTIC AND KIDS REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:LAREDO AUTISTIC AND KIDS REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-357-9196
Mailing Address - Street 1:3210 LOOP 20 STE 5
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-5010
Mailing Address - Country:US
Mailing Address - Phone:956-712-9111
Mailing Address - Fax:956-712-8421
Practice Address - Street 1:3210 LOOP 20 STE 5
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-5010
Practice Address - Country:US
Practice Address - Phone:956-712-9111
Practice Address - Fax:956-712-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)