Healthcare Provider Details

I. General information

NPI: 1932136256
Provider Name (Legal Business Name): SOUTH AUSTIN REHABILITATION & WOUND CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W BEN WHITE BLVD SUITE 100B
AUSTIN TX
78704-7667
US

IV. Provider business mailing address

1701 W BEN WHITE BLVD SUITE 100B
AUSTIN TX
78704-7667
US

V. Phone/Fax

Practice location:
  • Phone: 512-440-1441
  • Fax: 512-440-1448
Mailing address:
  • Phone: 512-440-1441
  • Fax: 512-440-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. PAUL JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-440-1441