Provider Demographics
NPI:1710352547
Name:STRIDE BY STRIDE REHAB LLC
Entity Type:Organization
Organization Name:STRIDE BY STRIDE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-460-1888
Mailing Address - Street 1:507 NORTHERN DANCER AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6964
Mailing Address - Country:US
Mailing Address - Phone:956-460-1888
Mailing Address - Fax:956-587-0245
Practice Address - Street 1:507 NORTHERN DANCER AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6964
Practice Address - Country:US
Practice Address - Phone:956-460-1888
Practice Address - Fax:956-587-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1184240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty