Provider Demographics
NPI:1811958259
Name:PASADENA OUTPATIENT REHAB CLINIC,LLC.
Entity type:Organization
Organization Name:PASADENA OUTPATIENT REHAB CLINIC,LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-447-9044
Mailing Address - Street 1:3501 MORELAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-9132
Mailing Address - Country:US
Mailing Address - Phone:956-447-9044
Mailing Address - Fax:956-968-0434
Practice Address - Street 1:3501 MORELAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-9132
Practice Address - Country:US
Practice Address - Phone:956-447-9044
Practice Address - Fax:956-968-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X, 235Z00000X
TX654380000261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168717001Medicaid
TX168717001Medicaid