Provider Demographics
NPI:1629209606
Name:ST. DAVID'S PHYSICAL MEDICINE AND REHABILITATION, PLLC
Entity Type:Organization
Organization Name:ST. DAVID'S PHYSICAL MEDICINE AND REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-708-9700
Mailing Address - Street 1:98 SAN JACINTO BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4082
Mailing Address - Country:US
Mailing Address - Phone:512-708-9700
Mailing Address - Fax:512-482-4191
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:SUITE 306
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-236-1310
Practice Address - Fax:512-236-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Single Specialty