Provider Demographics
NPI:1659390748
Name:LONG PRAIRIE REHABILITATION
Entity Type:Organization
Organization Name:LONG PRAIRIE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIPPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-874-7171
Mailing Address - Street 1:3301 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2702
Mailing Address - Country:US
Mailing Address - Phone:972-874-7171
Mailing Address - Fax:972-874-7110
Practice Address - Street 1:3301 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2702
Practice Address - Country:US
Practice Address - Phone:972-874-7171
Practice Address - Fax:972-874-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00367ZMedicare ID - Type Unspecified