Healthcare Provider Details

I. General information

NPI: 1104264605
Provider Name (Legal Business Name): RGV REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S JACKSON RD STE 2AND3
MCALLEN TX
78503-1588
US

IV. Provider business mailing address

4609 N JACKSON RD
MCALLEN TX
78504-6100
US

V. Phone/Fax

Practice location:
  • Phone: 956-630-4400
  • Fax: 956-630-4447
Mailing address:
  • Phone: 956-630-4400
  • Fax: 956-630-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JORGE A GONZALEZ
Title or Position: OWNER
Credential:
Phone: 956-630-4400