Provider Demographics
NPI:1154070621
Name:ALL STAR PEDIATRIC REHAB
Entity Type:Organization
Organization Name:ALL STAR PEDIATRIC REHAB
Other - Org Name:ALL STAR PEDIATRIC REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZETTH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-348-4284
Mailing Address - Street 1:3824 N GWIN RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-1370
Mailing Address - Country:US
Mailing Address - Phone:956-212-0324
Mailing Address - Fax:
Practice Address - Street 1:815 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5655
Practice Address - Country:US
Practice Address - Phone:956-348-4284
Practice Address - Fax:956-513-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101873OtherTDLR