MEDICARE: ENDEAVOR REHAB CENTER INC

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	225XH1200X	Hand Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1639361959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDEAVOR REHAB CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 932184
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-2184
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5632 EDWARDS RANCH RD STE 110
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4102
Country	:	US
Telephone Number	:	817-259-0600
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	AMANDA STREETER
Credential	:
Telephone Number	:	800-699-9395

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	11/18/2023

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