MEDICARE: CONCHO VALLEY REHAB, 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	111N00000X	Chiropractor	6606	TX
2	225100000X	Physical Therapist	1167940	TX

General Provider Information

NPI Number	:	1720199037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCHO VALLEY REHAB, P.A.

Provider Business Mailing Address
First Line	:	2215 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3701
Country	:	US
Telephone Number	:	325-224-8400
Fax Number	:	325-224-8405

Provider Business Practice Location Address
First Line	:	2215 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3701
Country	:	US
Telephone Number	:	325-224-8400
Fax Number	:	325-224-8405

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. TONY ROY SMITH
Credential	:	D.C.
Telephone Number	:	325-224-8400

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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