Provider Demographics
NPI:1649729310
Name:MR. CHESTER RHINES
Entity type:Organization
Organization Name:MR. CHESTER RHINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RHINES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-592-3021
Mailing Address - Street 1:4204 STONEBRAIR TRAIL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76030
Mailing Address - Country:US
Mailing Address - Phone:817-592-3021
Mailing Address - Fax:888-557-1669
Practice Address - Street 1:4204 STONEBRIAR TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5875
Practice Address - Country:US
Practice Address - Phone:817-592-3021
Practice Address - Fax:888-557-1669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHINESTONE RESOURCE GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171843251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506285OtherMEDICARE TRANSACTION NUMBER