Provider Demographics
NPI:1720104482
Name:REHAB SOURCE, INC
Entity type:Organization
Organization Name:REHAB SOURCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT REHAB SOURCE, INC
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:CAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:806-687-2788
Mailing Address - Street 1:6913 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413
Mailing Address - Country:US
Mailing Address - Phone:806-687-2788
Mailing Address - Fax:806-687-2791
Practice Address - Street 1:6913 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6111
Practice Address - Country:US
Practice Address - Phone:806-687-2788
Practice Address - Fax:806-687-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C2537Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUM
TX00292XMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER