Provider Demographics
NPI:1891819157
Name:ALL ABOUT REHAB LLC
Entity Type:Organization
Organization Name:ALL ABOUT REHAB LLC
Other - Org Name:PEDIATRIC REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:817-377-2535
Mailing Address - Street 1:3550 HULEN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6885
Mailing Address - Country:US
Mailing Address - Phone:817-377-2535
Mailing Address - Fax:817-292-0572
Practice Address - Street 1:1836 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6422
Practice Address - Country:US
Practice Address - Phone:817-377-2535
Practice Address - Fax:817-292-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67-6681261QR0400X
261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
85PQOtherBCBS
TX3000168-01Medicaid
676681Medicare Oscar/Certification