Provider Demographics
NPI:1861677130
Name:TOWN EAST REHABILITATION, LLC
Entity Type:Organization
Organization Name:TOWN EAST REHABILITATION, LLC
Other - Org Name:TOWN EAST REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANKSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-613-4334
Mailing Address - Street 1:1125 TOWN EAST MALL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4117
Mailing Address - Country:US
Mailing Address - Phone:972-613-4334
Mailing Address - Fax:972-613-4335
Practice Address - Street 1:1125 TOWN EAST MALL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4117
Practice Address - Country:US
Practice Address - Phone:972-613-4334
Practice Address - Fax:972-613-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64610000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy