Provider Demographics
NPI:1770004483
Name:RGV PHYSICAL THERAPY & AQUATIC REHAB, LLC
Entity Type:Organization
Organization Name:RGV PHYSICAL THERAPY & AQUATIC REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-460-7840
Mailing Address - Street 1:1132 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-6993
Mailing Address - Country:US
Mailing Address - Phone:956-460-7840
Mailing Address - Fax:
Practice Address - Street 1:515 E BUSINESS HWY 83 STE B
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2526
Practice Address - Country:US
Practice Address - Phone:956-460-7840
Practice Address - Fax:956-720-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112498261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID #