Provider Demographics
NPI:1801817622
Name:PNI REHAB CENTERS, LLC
Entity Type:Organization
Organization Name:PNI REHAB CENTERS, LLC
Other - Org Name:PAIN & INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEGAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-436-4434
Mailing Address - Street 1:363 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3867
Mailing Address - Country:US
Mailing Address - Phone:972-436-4434
Mailing Address - Fax:972-436-3182
Practice Address - Street 1:363 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3867
Practice Address - Country:US
Practice Address - Phone:972-436-4434
Practice Address - Fax:972-436-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9326261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty