Provider Demographics
NPI:1962646315
Name:BULVERDE REHABILITATION & WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:BULVERDE REHABILITATION & WELLNESS CENTER PLLC
Other - Org Name:BULVERDE PHYSICAL THERAPY & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-980-4055
Mailing Address - Street 1:20475 HWY 46W
Mailing Address - Street 2:#150
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6180
Mailing Address - Country:US
Mailing Address - Phone:830-980-4055
Mailing Address - Fax:830-438-4085
Practice Address - Street 1:20475 HWY 46W
Practice Address - Street 2:#150
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6180
Practice Address - Country:US
Practice Address - Phone:830-980-4055
Practice Address - Fax:830-438-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX633230000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036EFOtherBC/BS