Provider Demographics
NPI:1518486372
Name:INTEGRATED HEALTH-REHAB, LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH-REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-329-8764
Mailing Address - Street 1:500 FLOWER MOUND RD SPC 104
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3418
Mailing Address - Country:US
Mailing Address - Phone:915-329-8764
Mailing Address - Fax:214-285-1014
Practice Address - Street 1:500 FLOWER MOUND RD SPC 104
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3418
Practice Address - Country:US
Practice Address - Phone:915-329-8764
Practice Address - Fax:915-329-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2071208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty