Provider Demographics
NPI:1285956771
Name:SOUTHWEST ABILENE REHAB, PA
Entity type:Organization
Organization Name:SOUTHWEST ABILENE REHAB, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:SHAWNEE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-313-2514
Mailing Address - Street 1:342 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601
Mailing Address - Country:US
Mailing Address - Phone:830-776-5996
Mailing Address - Fax:830-776-5992
Practice Address - Street 1:2435 N VETERANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6483
Practice Address - Country:US
Practice Address - Phone:830-776-5996
Practice Address - Fax:830-776-5992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST ABILENE REHAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-24
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5128111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217704001Medicaid
TXTXB107481Medicare UPIN