Provider Demographics
NPI:1225688567
Name:ENVISION REHAB LLC
Entity Type:Organization
Organization Name:ENVISION REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:512-925-8857
Mailing Address - Street 1:30126 DIAMOND DOVE TRL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3724
Mailing Address - Country:US
Mailing Address - Phone:512-925-8857
Mailing Address - Fax:
Practice Address - Street 1:3621 E WHITESTONE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7073
Practice Address - Country:US
Practice Address - Phone:512-925-8857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy