Provider Demographics
NPI:1548205743
Name:ANGLETON REHABILITATION AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ANGLETON REHABILITATION AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-864-3821
Mailing Address - Street 1:PO BOX 41027
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77241-1027
Mailing Address - Country:US
Mailing Address - Phone:979-864-3821
Mailing Address - Fax:979-848-8563
Practice Address - Street 1:2327 W HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-7455
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:2006-06-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650330000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160157701Medicaid
TX160157701Medicaid