Provider Demographics
NPI:1659531226
Name:HERALD REHABILITATION, LLC
Entity Type:Organization
Organization Name:HERALD REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMEL
Authorized Official - Middle Name:BEJOSANO
Authorized Official - Last Name:VIDENA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:469-358-5166
Mailing Address - Street 1:4329 BENTON ELM DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7279
Mailing Address - Country:US
Mailing Address - Phone:972-424-6423
Mailing Address - Fax:972-424-6519
Practice Address - Street 1:621 W PLANO PKWY
Practice Address - Street 2:SUITE 241
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8966
Practice Address - Country:US
Practice Address - Phone:972-424-6423
Practice Address - Fax:972-424-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty