Provider Demographics
NPI:1013289792
Name:ROBERT HORRY CENTER FOR SPORTS AND PHYSICAL REHABILITATION, LLC
Entity Type:Organization
Organization Name:ROBERT HORRY CENTER FOR SPORTS AND PHYSICAL REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-277-0751
Mailing Address - Street 1:15591 CREEK BEND DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3381
Mailing Address - Country:US
Mailing Address - Phone:281-277-0751
Mailing Address - Fax:281-277-0761
Practice Address - Street 1:15591 CREEK BEND DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3381
Practice Address - Country:US
Practice Address - Phone:281-277-0751
Practice Address - Fax:281-277-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670760000225100000X
TX563360000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty