Provider Demographics
NPI:1982929246
Name:LAGUNA MADRE REHABILITATION CENTER
Entity Type:Organization
Organization Name:LAGUNA MADRE REHABILITATION CENTER
Other - Org Name:LAGUNA MADRE REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PLATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-943-1028
Mailing Address - Street 1:225 MESQUITE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2708
Mailing Address - Country:US
Mailing Address - Phone:956-943-1028
Mailing Address - Fax:956-943-1036
Practice Address - Street 1:1200 STATE HIGHWAY 100
Practice Address - Street 2:STE 3
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2462
Practice Address - Country:US
Practice Address - Phone:956-943-1028
Practice Address - Fax:956-943-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty