Provider Demographics
NPI:1093716078
Name:PHYSICAL MEDICINE REHAB, LLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE REHAB, LLC
Other - Org Name:PHYSICAL THERAPY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:INFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-725-5212
Mailing Address - Street 1:101 W HILLSIDE RD
Mailing Address - Street 2:STE 6-B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3141
Mailing Address - Country:US
Mailing Address - Phone:956-725-5212
Mailing Address - Fax:956-796-1117
Practice Address - Street 1:101 W HILLSIDE RD
Practice Address - Street 2:STE 6-B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3141
Practice Address - Country:US
Practice Address - Phone:956-725-5212
Practice Address - Fax:956-796-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08778Z101Medicaid
TX08778Z101Medicaid
802T07Medicare ID - Type Unspecified