Provider Demographics
NPI:1144413212
Name:UNIVERSAL REHAB CENTER, PA
Entity Type:Organization
Organization Name:UNIVERSAL REHAB CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:REGALADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-733-9090
Mailing Address - Street 1:3232 IH 10 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5101
Mailing Address - Country:US
Mailing Address - Phone:210-733-9090
Mailing Address - Fax:210-733-9093
Practice Address - Street 1:3232 IH 10 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5101
Practice Address - Country:US
Practice Address - Phone:210-733-9090
Practice Address - Fax:210-733-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty