Provider Demographics
NPI:1881602977
Name:LISARA REHAB CENTER
Entity type:Organization
Organization Name:LISARA REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:210-614-3003
Mailing Address - Street 1:7220 LOUIS PASTEUR DR STE 106
Mailing Address - Street 2:4319 MEDICAL 131-113
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4537
Mailing Address - Country:US
Mailing Address - Phone:210-614-3003
Mailing Address - Fax:210-692-7898
Practice Address - Street 1:7220 LOUIS PASTEUR DR STE 106
Practice Address - Street 2:4319 MEDICAL 131-113
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4537
Practice Address - Country:US
Practice Address - Phone:210-614-3003
Practice Address - Fax:210-692-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019KXOtherBCBS GROUP NUMBER
TX00264WMedicare ID - Type UnspecifiedMEDICARE PROVIDER