Provider Demographics
NPI:1598060287
Name:REHABILITATION HOSPITAL OF DENTON
Entity Type:Organization
Organization Name:REHABILITATION HOSPITAL OF DENTON
Other - Org Name:SELECT REHABILITATION HOSPITAL OF DENTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:940-297-6500
Mailing Address - Street 1:2620 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4315
Mailing Address - Country:US
Mailing Address - Phone:940-297-6500
Mailing Address - Fax:940-297-6535
Practice Address - Street 1:2620 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4315
Practice Address - Country:US
Practice Address - Phone:940-297-6500
Practice Address - Fax:940-297-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105460283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673036Medicare UPIN