Provider Demographics
NPI:1093865081
Name:REHAB 2112, LLC
Entity Type:Organization
Organization Name:REHAB 2112, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RHUDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-378-4499
Mailing Address - Street 1:718 N BUCKNER BLVD STE 138
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2764
Mailing Address - Country:US
Mailing Address - Phone:214-367-8807
Mailing Address - Fax:214-367-8864
Practice Address - Street 1:718 N BUCKNER BLVD STE 138
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2764
Practice Address - Country:US
Practice Address - Phone:214-367-8807
Practice Address - Fax:214-367-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation