Provider Demographics
NPI:1750945853
Name:FLORES PEDIATRIC REHAB, LLC
Entity type:Organization
Organization Name:FLORES PEDIATRIC REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-638-6162
Mailing Address - Street 1:3012 E. MAIN AVE SUITE H & I
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-7995
Mailing Address - Country:US
Mailing Address - Phone:956-638-6162
Mailing Address - Fax:956-435-0146
Practice Address - Street 1:3012 E MAIN AVE STE H
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-0908
Practice Address - Country:US
Practice Address - Phone:956-638-6162
Practice Address - Fax:956-435-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2077521OtherPT THERAPY LICENSE