Provider Demographics
NPI:1114782133
Name:POWER PERFORMANCE AND REHABILITATION
Entity Type:Organization
Organization Name:POWER PERFORMANCE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RUVALCABA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:915-920-2360
Mailing Address - Street 1:11911 GREENVILLE AVE APT 2314
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3671
Mailing Address - Country:US
Mailing Address - Phone:915-920-2360
Mailing Address - Fax:
Practice Address - Street 1:11911 GREENVILLE AVE APT 2314
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3671
Practice Address - Country:US
Practice Address - Phone:915-920-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty