Provider Demographics
NPI:1154377547
Name:OMNI REHAB SPECIALISTS, LLC
Entity type:Organization
Organization Name:OMNI REHAB SPECIALISTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:HEILERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-592-5579
Mailing Address - Street 1:118 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4502
Mailing Address - Country:US
Mailing Address - Phone:281-592-5579
Mailing Address - Fax:281-592-8941
Practice Address - Street 1:118 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4502
Practice Address - Country:US
Practice Address - Phone:281-592-5579
Practice Address - Fax:281-592-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664450000261QR0401X
TXPT1062222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021745701Medicaid
TX021745701Medicaid