Provider Demographics
NPI:1780694562
Name:FITNESS & REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:FITNESS & REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARNDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:979-297-3365
Mailing Address - Street 1:321 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6238
Mailing Address - Country:US
Mailing Address - Phone:979-297-3365
Mailing Address - Fax:979-297-3541
Practice Address - Street 1:321 GARLAND DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6238
Practice Address - Country:US
Practice Address - Phone:979-297-3365
Practice Address - Fax:979-297-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U60FOtherBCBS
TX00W399Medicare PIN
TX00U60FOtherBCBS