Provider Demographics
NPI:1760105001
Name:210 REHABILITATION, LLC
Entity Type:Organization
Organization Name:210 REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT
Authorized Official - Phone:210-816-0689
Mailing Address - Street 1:311 EDGEVALE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4204
Mailing Address - Country:US
Mailing Address - Phone:210-816-0689
Mailing Address - Fax:
Practice Address - Street 1:311 EDGEVALE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4204
Practice Address - Country:US
Practice Address - Phone:210-816-0689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty