Healthcare Provider Details

I. General information

NPI: 1831636869
Provider Name (Legal Business Name): MEDREHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2017
Last Update Date: 09/27/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 JONES RD STE C
AUSTIN TX
78745-2682
US

IV. Provider business mailing address

2619 JONES RD STE C
AUSTIN TX
78745-2682
US

V. Phone/Fax

Practice location:
  • Phone: 512-792-9501
  • Fax: 512-792-9534
Mailing address:
  • Phone: 512-792-9501
  • Fax: 512-792-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: GINA KAY STANGO
Title or Position: OWNER/CEO
Credential: OTR/L, OTD, MOT, ATP
Phone: 512-792-9501