Provider Demographics
NPI:1356673073
Name:SOUTH TEXAS CHILDREN'S REHAB
Entity type:Organization
Organization Name:SOUTH TEXAS CHILDREN'S REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:956-622-5059
Mailing Address - Street 1:425 E. LOS EBANOS BLVD.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8443
Mailing Address - Country:US
Mailing Address - Phone:956-622-5059
Mailing Address - Fax:956-554-0540
Practice Address - Street 1:425 E. LOS EBANOS BLVD.
Practice Address - Street 2:SUITE 109
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8443
Practice Address - Country:US
Practice Address - Phone:956-622-5059
Practice Address - Fax:956-554-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation