Provider Demographics
NPI:1982822060
Name:ORTHOPAEDIC & NEUROMUSCULAR REHABILITATION INSTITUTE
Entity Type:Organization
Organization Name:ORTHOPAEDIC & NEUROMUSCULAR REHABILITATION INSTITUTE
Other - Org Name:PHYSICAL REHABILITATION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:INMAN
Authorized Official - Last Name:BUSSEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT
Authorized Official - Phone:210-545-9355
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294-0977
Mailing Address - Country:US
Mailing Address - Phone:210-572-6313
Mailing Address - Fax:210-545-9369
Practice Address - Street 1:19260 STONE OAK PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3365
Practice Address - Country:US
Practice Address - Phone:210-545-9355
Practice Address - Fax:210-545-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX634740000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003ESOtherBLUE CROSS BLUE SHIELD
TX000121SMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER