Provider Demographics
NPI:1083653000
Name:MATRIX REHABILITATION -TEXAS, INC.
Entity Type:Organization
Organization Name:MATRIX REHABILITATION -TEXAS, INC.
Other - Org Name:MATRIX REHABILITATION OF WYLIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:335 ROSELANE ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7902
Mailing Address - Country:US
Mailing Address - Phone:470-259-5226
Mailing Address - Fax:267-321-2044
Practice Address - Street 1:600 COOPER DR
Practice Address - Street 2:STE 130
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3910
Practice Address - Country:US
Practice Address - Phone:972-442-6525
Practice Address - Fax:972-442-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456881Medicare Oscar/Certification