Provider Demographics
NPI:1477628170
Name:RGV NUECES REHABILITATION INC.
Entity Type:Organization
Organization Name:RGV NUECES REHABILITATION INC.
Other - Org Name:INNOVATIVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-986-0708
Mailing Address - Street 1:4455 S PADRE ISLAND DR STE 8
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5166
Mailing Address - Country:US
Mailing Address - Phone:361-986-0708
Mailing Address - Fax:361-986-0751
Practice Address - Street 1:4455 S PADRE ISLAND DR STE 8
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5166
Practice Address - Country:US
Practice Address - Phone:361-986-0708
Practice Address - Fax:361-986-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1162377OtherTEXAS STATE LICENES