Provider Demographics
NPI:1487658050
Name:RGV-NUECES REHABILITATION, INC.
Entity Type:Organization
Organization Name:RGV-NUECES REHABILITATION, INC.
Other - Org Name:INNOVATIVE PHYSICAL THERAPY & SPORTS MEDICINE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-921-2111
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-1329
Mailing Address - Country:US
Mailing Address - Phone:210-921-2111
Mailing Address - Fax:210-921-2444
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 465
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3758
Practice Address - Country:US
Practice Address - Phone:210-921-2111
Practice Address - Fax:210-921-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629340000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI070440OtherINTERPLAN HEALTH PLAN
TX6400150OtherUNITED HEALTHCARE
TX10066488OtherAMERIGROUP
TX7712156OtherAETNA
TX0079DLOtherBCBS
TX080735601Medicaid
TXI070440OtherINTERPLAN HEALTH PLAN
TX10066488OtherAMERIGROUP
TXQ19137Medicare UPIN
TXP78693Medicare UPIN