Healthcare Provider Details

I. General information

NPI: 1619037629
Provider Name (Legal Business Name): EAGLE WARD REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 ANDERSON MILL RD. SUITE 340
AUSTIN TX
78750-3227
US

IV. Provider business mailing address

9707 ANDERSON MILL RD SUITE 340
AUSTIN TX
78750-3227
US

V. Phone/Fax

Practice location:
  • Phone: 512-258-5300
  • Fax: 512-258-4475
Mailing address:
  • Phone: 512-258-5300
  • Fax: 512-258-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number625280002
License Number StateTX

VIII. Authorized Official

Name: MR. CHRISTOPHER TODD EAGLE
Title or Position: PRESIDENT
Credential:
Phone: 512-258-5300