Provider Demographics
NPI:1124357801
Name:XANADU REHABILITATION, INC.
Entity Type:Organization
Organization Name:XANADU REHABILITATION, INC.
Other - Org Name:THERAPY CENTER OF BUDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-295-2273
Mailing Address - Street 1:360 OYSTER CRK
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5178
Mailing Address - Country:US
Mailing Address - Phone:512-785-7887
Mailing Address - Fax:512-312-9353
Practice Address - Street 1:1750 FM 967 STE A
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2884
Practice Address - Country:US
Practice Address - Phone:512-295-2273
Practice Address - Fax:512-295-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
TX24694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188455303Medicaid
TX188455304Medicaid