Provider Demographics
NPI:1992945406
Name:REHABILITY THERAPY CENTER LLC
Entity type:Organization
Organization Name:REHABILITY THERAPY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-283-7555
Mailing Address - Street 1:1110 S STEWART RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-5168
Mailing Address - Country:US
Mailing Address - Phone:956-283-7555
Mailing Address - Fax:956-283-7557
Practice Address - Street 1:1110 S STEWART RD STE D
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-283-7555
Practice Address - Fax:956-283-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210777301Medicaid
TX676573OtherMEDICARE TRAILBLAZER
TX676573OtherMEDICARE- NOVITAS SOLUTIONS, INC.