Healthcare Provider Details

I. General information

NPI: 1871653725
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 MARATHON BLVD
AUSTIN TX
78756
US

IV. Provider business mailing address

5300 BEE CAVE RD BLDG 1 SUITE 100
AUSTIN TX
78746
US

V. Phone/Fax

Practice location:
  • Phone: 512-302-1930
  • Fax: 512-302-4023
Mailing address:
  • Phone: 512-732-0102
  • Fax: 512-732-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRISTOPHER TODD EAGLE
Title or Position: PRESIDENT
Credential:
Phone: 512-732-0102