Provider Demographics
NPI:1225273253
Name:COMMUNITY HEALTH AND REHABILITATION CENTRE PC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AND REHABILITATION CENTRE PC
Other - Org Name:MARK C. LESKO, DC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LESKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-835-6077
Mailing Address - Street 1:2013 WELLS BRANCH PKWY
Mailing Address - Street 2:# 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6903
Mailing Address - Country:US
Mailing Address - Phone:512-835-6077
Mailing Address - Fax:512-835-6079
Practice Address - Street 1:2013 WELLS BRANCH PKWY
Practice Address - Street 2:# 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6903
Practice Address - Country:US
Practice Address - Phone:512-835-6077
Practice Address - Fax:512-835-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4597111N00000X
TX1178892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8188208OtherBLUE LINK
TX8188208OtherBLUE LINK
TX0A3888 PTAN PART BMedicare PIN
TX603601Medicare PIN
TX67-6666 PTAN PART AMedicare PIN