Provider Demographics
NPI:1952337578
Name:ONE SOURCE REHABILITATION, INC.
Entity Type:Organization
Organization Name:ONE SOURCE REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMINITI
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:281-482-1632
Mailing Address - Street 1:3348 E FM 528 RD
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5012
Mailing Address - Country:US
Mailing Address - Phone:281-482-1632
Mailing Address - Fax:
Practice Address - Street 1:3348 E FM 528 RD
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5012
Practice Address - Country:US
Practice Address - Phone:281-482-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN/A261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
454576Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER