MEDICARE: VALLEY PM&R SPECIALISTS, P.A.

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
1	208100000X	Physical Medicine & Rehabilitation Physician	J9418	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0066DJ	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1538167549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PM&R SPECIALISTS, P.A.

Provider Business Mailing Address
First Line	:	1200 E SAVANNAH AVE
Second Line	:	STE 10
City	:	MCALLEN
State	:	TX
Zip	:	78503-1727
Country	:	US
Telephone Number	:	956-668-9900
Fax Number	:	956-668-9902

Provider Business Practice Location Address
First Line	:	1200 E SAVANNAH AVE
Second Line	:	STE 10
City	:	MCALLEN
State	:	TX
Zip	:	78503-1727
Country	:	US
Telephone Number	:	956-668-9900
Fax Number	:	956-668-9902

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAROJA VISWAMITRA
Credential	:	MD
Telephone Number	:	956-668-9900

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/31/2007

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Practice Location Address:

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1417928326 — SUBBARAO YARRA MD
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1902878721 — DR. GUILLERMO L MONTANEZ JR. MD
Practice Location Address:

1200 E SAVANNAH AVE , SUITE 18
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Practice Location Address:

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1174587471 — CHARLES JEFFERSON HINES M.D.
Practice Location Address:

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