Provider Demographics
NPI:1811197155
Name:RYKE REHABILITATION, LLC
Entity Type:Organization
Organization Name:RYKE REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUISNESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-337-7953
Mailing Address - Street 1:3875 E SOUTHCROSS BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3521
Mailing Address - Country:US
Mailing Address - Phone:210-337-7953
Mailing Address - Fax:210-337-7966
Practice Address - Street 1:12315 JUDSON RD
Practice Address - Street 2:200
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3277
Practice Address - Country:US
Practice Address - Phone:210-656-7953
Practice Address - Fax:210-656-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00974XOtherMEDICARE GROUP PTAN NUMBE