Provider Demographics
NPI:1366630980
Name:PHYSICIANS REHAB ASSOCIATES P. A.
Entity Type:Organization
Organization Name:PHYSICIANS REHAB ASSOCIATES P. A.
Other - Org Name:LORDEX SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DOWLING
Authorized Official - Last Name:DEES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-570-7354
Mailing Address - Street 1:3708 N NAVARRO ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2619
Mailing Address - Country:US
Mailing Address - Phone:361-570-7354
Mailing Address - Fax:361-570-7356
Practice Address - Street 1:3708 N NAVARRO ST
Practice Address - Street 2:SUITE C
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2619
Practice Address - Country:US
Practice Address - Phone:361-570-7354
Practice Address - Fax:361-570-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59897Medicare UPIN
TX00389XMedicare PIN