Provider Demographics
NPI:1962495580
Name:MISSION REHABILITATION SERVICES
Entity Type:Organization
Organization Name:MISSION REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:806-792-7125
Mailing Address - Street 1:1901 W LOOP 289
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-1713
Mailing Address - Country:US
Mailing Address - Phone:806-792-7125
Mailing Address - Fax:806-792-7121
Practice Address - Street 1:1901 W LOOP 289
Practice Address - Street 2:SUITE 3
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-1713
Practice Address - Country:US
Practice Address - Phone:806-792-7125
Practice Address - Fax:806-792-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629990000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155968401Medicaid
TX00023SMedicare Oscar/Certification