Provider Demographics
NPI:1215187356
Name:PRO REHAB ASSOCIATES PA
Entity Type:Organization
Organization Name:PRO REHAB ASSOCIATES PA
Other - Org Name:MANSFIELD PHYSICAL MEDICINE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:BHARAT
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-453-0430
Mailing Address - Street 1:221 REGENCY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5379
Mailing Address - Country:US
Mailing Address - Phone:817-453-0430
Mailing Address - Fax:817-453-0400
Practice Address - Street 1:221 REGENCY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5379
Practice Address - Country:US
Practice Address - Phone:817-453-0430
Practice Address - Fax:817-453-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10852111N00000X
2086S0129X
TX1600213ES0103X
TX1167330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4631Medicare PIN
TX422198Medicare PIN