Provider Demographics
NPI:1104198217
Name:GO-GO KIDS REHAB,LLC
Entity Type:Organization
Organization Name:GO-GO KIDS REHAB,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-566-0722
Mailing Address - Street 1:912 E NOLANA LOOP STE H-I
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5838
Mailing Address - Country:US
Mailing Address - Phone:956-566-9722
Mailing Address - Fax:956-720-0882
Practice Address - Street 1:101 PREMIERE LN
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-1932
Practice Address - Country:US
Practice Address - Phone:956-566-0722
Practice Address - Fax:956-720-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671930000225100000X
TX564270000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty