Provider Demographics
NPI:1629486683
Name:TOTAL BODY REHAB, INC
Entity Type:Organization
Organization Name:TOTAL BODY REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAMBULA-FALLAD
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:956-568-2105
Mailing Address - Street 1:1520 E SAN PEDRO ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5429
Mailing Address - Country:US
Mailing Address - Phone:956-568-2105
Mailing Address - Fax:956-568-1488
Practice Address - Street 1:1520 E SAN PEDRO ST
Practice Address - Street 2:STE 102
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5479
Practice Address - Country:US
Practice Address - Phone:956-568-2105
Practice Address - Fax:956-568-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101443261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86TT15OtherBLUE CROSS BLUE SHIELD
TX1574428OtherMEDICAID