Provider Demographics
NPI:1568800316
Name:UNIQUE PEDIATIC REHAB CENTER LLC
Entity Type:Organization
Organization Name:UNIQUE PEDIATIC REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPMB
Authorized Official - Phone:956-838-9791
Mailing Address - Street 1:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-0796
Mailing Address - Country:US
Mailing Address - Phone:956-583-8772
Mailing Address - Fax:956-583-8774
Practice Address - Street 1:7602 W INTERSTATE HIGHWAY 2 STE B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9722
Practice Address - Country:US
Practice Address - Phone:956-583-8772
Practice Address - Fax:956-583-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113800225X00000X
TX101572235Z00000X
TX101001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2075962-07Medicaid
TX3126898-01Medicaid
TX356990701Medicaid