Provider Demographics
NPI:1407113525
Name:WEST PARK REHAB & AQUATIC CENTER
Entity Type:Organization
Organization Name:WEST PARK REHAB & AQUATIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:936-328-8080
Mailing Address - Street 1:210 W PARK
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8336
Mailing Address - Country:US
Mailing Address - Phone:936-327-8080
Mailing Address - Fax:936-327-8086
Practice Address - Street 1:210 W PARK
Practice Address - Street 2:SUITE 101
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8336
Practice Address - Country:US
Practice Address - Phone:936-327-8080
Practice Address - Fax:936-327-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy