Provider Demographics
NPI:1700060738
Name:STONERIDGE PHYSICAL REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:STONERIDGE PHYSICAL REHABILITATION CENTER, INC
Other - Org Name:STONERIDGE INJURY & ACCIDENT CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-664-8333
Mailing Address - Street 1:PO BOX 6463
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502
Mailing Address - Country:US
Mailing Address - Phone:956-664-8333
Mailing Address - Fax:956-618-3952
Practice Address - Street 1:4752 S. JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-664-8333
Practice Address - Fax:956-618-3952
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONERIDGE PHYSICAL REHABILITATION CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8120111N00000X
TXDC5068111N00000X
TXPT1106128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty