Provider Demographics
NPI:1356503965
Name:LIBRE REHAB STAFFING, LLC
Entity Type:Organization
Organization Name:LIBRE REHAB STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:512-589-1372
Mailing Address - Street 1:1818 S LAKESHORE BLVD
Mailing Address - Street 2:#33
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1249
Mailing Address - Country:US
Mailing Address - Phone:512-589-1372
Mailing Address - Fax:512-436-9241
Practice Address - Street 1:1818 S LAKESHORE BLVD
Practice Address - Street 2:#33
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1249
Practice Address - Country:US
Practice Address - Phone:512-589-1372
Practice Address - Fax:512-436-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty