Provider Demographics
NPI:1265881197
Name:RELIANT PRO REHAB LLC
Entity type:Organization
Organization Name:RELIANT PRO REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF STRATEGY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:801-599-2610
Mailing Address - Street 1:5800 GRANITE PKWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6619
Mailing Address - Country:US
Mailing Address - Phone:801-599-2610
Mailing Address - Fax:866-422-5051
Practice Address - Street 1:5800 GRANITE PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6619
Practice Address - Country:US
Practice Address - Phone:972-890-9095
Practice Address - Fax:866-422-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty