Provider Demographics
NPI:1487214623
Name:REJUVENATE THERAPY OF TEXAS, INC
Entity Type:Organization
Organization Name:REJUVENATE THERAPY OF TEXAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-387-3577
Mailing Address - Street 1:8401 CRAWFORD AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2154
Mailing Address - Country:US
Mailing Address - Phone:847-423-2625
Mailing Address - Fax:847-787-1663
Practice Address - Street 1:2660 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5222
Practice Address - Country:US
Practice Address - Phone:847-423-2625
Practice Address - Fax:847-787-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty