Healthcare Provider Details

I. General information

NPI: 1124357801
Provider Name (Legal Business Name): XANADU REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 FM 967 STE A
BUDA TX
78610-2884
US

IV. Provider business mailing address

1750 FM 967 # A
BUDA TX
78610-3461
US

V. Phone/Fax

Practice location:
  • Phone: 512-295-2273
  • Fax: 512-295-2280
Mailing address:
  • Phone: 512-295-2273
  • Fax: 512-295-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24694
License Number StateTX

VIII. Authorized Official

Name: MS. AMY GRANT
Title or Position: CO-OWNER
Credential:
Phone: 512-295-2273