Provider Demographics
NPI:1720026123
Name:MATRIX REHABILITATION-TEXAS, INC.
Entity Type:Organization
Organization Name:MATRIX REHABILITATION-TEXAS, INC.
Other - Org Name:MATRIX REHABILITATION OF FRISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:335 ROSELANE ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7902
Mailing Address - Country:US
Mailing Address - Phone:470-259-5226
Mailing Address - Fax:267-321-2044
Practice Address - Street 1:8204 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5536
Practice Address - Country:US
Practice Address - Phone:972-335-1407
Practice Address - Fax:972-335-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456877Medicare Oscar/Certification