Provider Demographics
NPI:1083750483
Name:REHABILITATION GROUP P A
Entity Type:Organization
Organization Name:REHABILITATION GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIEDZIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-3225
Mailing Address - Street 1:2701 BABCOCK RD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4800
Mailing Address - Country:US
Mailing Address - Phone:210-614-3225
Mailing Address - Fax:
Practice Address - Street 1:2701 BABCOCK RD
Practice Address - Street 2:STE A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4800
Practice Address - Country:US
Practice Address - Phone:210-614-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082428601Medicaid
TX00F20LOtherBCBS GROUP #
TX082428601Medicaid