Provider Demographics
NPI:1578556049
Name:BIG COUNTRY REHABILITATION INC
Entity Type:Organization
Organization Name:BIG COUNTRY REHABILITATION INC
Other - Org Name:REBOUND SPORTS & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-691-0093
Mailing Address - Street 1:1710 S CLACK ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4611
Mailing Address - Country:US
Mailing Address - Phone:325-691-0093
Mailing Address - Fax:325-691-0062
Practice Address - Street 1:1710 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4611
Practice Address - Country:US
Practice Address - Phone:325-691-0093
Practice Address - Fax:325-691-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057495261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80221TOtherBLUE CROSS BLUE SHIELD
TX021719201Medicaid
TX021719201Medicaid