Healthcare Provider Details

I. General information

NPI: 1619045234
Provider Name (Legal Business Name): RGV NUECES REHABILITATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 DEL MAR BLVD SUITE 14
LAREDO TX
78041
US

IV. Provider business mailing address

1605 DEL MAR BLVD SUITE 14
LAREDO TX
78041
US

V. Phone/Fax

Practice location:
  • Phone: 361-986-0708
  • Fax: 361-986-0751
Mailing address:
  • Phone: 361-986-0708
  • Fax: 361-986-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1164580
License Number StateTX

VIII. Authorized Official

Name: MRS. CHRISTINA ENER
Title or Position: ADMINISTRATOR
Credential:
Phone: 361-986-0708