Provider Demographics
NPI:1508801747
Name:ANGLETON REHABILITATION AND WELLNESS CENTER, LTD
Entity Type:Organization
Organization Name:ANGLETON REHABILITATION AND WELLNESS CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-848-1886
Mailing Address - Street 1:421 S VELASCO ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-6015
Mailing Address - Country:US
Mailing Address - Phone:979-848-1886
Mailing Address - Fax:979-848-1376
Practice Address - Street 1:421 S VELASCO ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-6015
Practice Address - Country:US
Practice Address - Phone:979-848-1886
Practice Address - Fax:979-848-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650330001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00378VMedicare ID - Type Unspecified