Provider Demographics
NPI:1063574671
Name:RURAL REHAB PROVIDERS, LLC
Entity type:Organization
Organization Name:RURAL REHAB PROVIDERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MN, CNS, FNP
Authorized Official - Phone:903-388-4983
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-1241
Mailing Address - Country:US
Mailing Address - Phone:903-389-7433
Mailing Address - Fax:903-389-7631
Practice Address - Street 1:1026 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3702
Practice Address - Country:US
Practice Address - Phone:903-874-7433
Practice Address - Fax:903-389-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003GROtherBCBS
TX145100701Medicaid