Healthcare Provider Details

I. General information

NPI: 1982948972
Provider Name (Legal Business Name): D.C. REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 CORONA DR SUITE 140
CORPUS CHRISTI TX
78411-4320
US

IV. Provider business mailing address

4646 CORONA DR SUITE 140
CORPUS CHRISTI TX
78411-4320
US

V. Phone/Fax

Practice location:
  • Phone: 361-980-8119
  • Fax:
Mailing address:
  • Phone: 361-980-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES TANNER
Title or Position: AGENT
Credential: D.C.
Phone: 361-980-8119