Healthcare Provider Details

I. General information

NPI: 1770004483
Provider Name (Legal Business Name): RGV PHYSICAL THERAPY & AQUATIC REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E BUSINESS HWY 83 STE B
ALAMO TX
78516-2526
US

IV. Provider business mailing address

1132 S 7TH ST
ALAMO TX
78516-6993
US

V. Phone/Fax

Practice location:
  • Phone: 956-460-7840
  • Fax: 956-720-4222
Mailing address:
  • Phone: 956-460-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1112498
License Number StateTX

VIII. Authorized Official

Name: JORGE ESCOBEDO
Title or Position: OWNER
Credential: PT
Phone: 956-460-7840