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NPI Code Detail

MEDICARE: ANGEL LEAF REHAB AND CONSULTING LLC

MEDICARE: ANGEL LEAF REHAB AND CONSULTING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3174400000XSpecialist

General Provider Information

NPI Number : 1053691352
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGEL LEAF REHAB AND CONSULTING LLC
Provider Business Mailing Address
First Line : 337 SHERI LN
Second Line :
City : LAKE JACKSON
State : TX
Zip : 77566-3269
Country : US
Telephone Number : 281-229-0263
Fax Number :
Provider Business Practice Location Address
First Line : 309 PLANTATION DR
Second Line :
City : LAKE JACKSON
State : TX
Zip : 77566-6142
Country : US
Telephone Number : 979-418-7165
Fax Number : 800-419-5153
Authorized Official
Title or Position : CEO
Name : EDNA LUCIO
Credential : OTR
Telephone Number : 281-229-0263
Provider Enumeration Date : 08/18/2011
Last Update Date : 07/29/2025

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Directions to “ANGEL LEAF REHAB AND CONSULTING LLC ” Practice Location

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