Provider Demographics
NPI:1487019873
Name:ELIJAH'S HAND PEDIATRIC REHAB
Entity Type:Organization
Organization Name:ELIJAH'S HAND PEDIATRIC REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BERENIZ
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-900-5205
Mailing Address - Street 1:137 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-5205
Mailing Address - Country:US
Mailing Address - Phone:830-900-5205
Mailing Address - Fax:830-900-5252
Practice Address - Street 1:137 N HIGH ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5205
Practice Address - Country:US
Practice Address - Phone:830-900-5205
Practice Address - Fax:830-900-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221239225100000X
TX113061225X00000X
TX104549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216402205Medicaid
TX351746801Medicaid
TX353500701Medicaid