Healthcare Provider Details

I. General information

NPI: 1639669799
Provider Name (Legal Business Name): ZOOM REHABILITATION,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N VIRGINIA ST
PORT LAVACA TX
77979-3449
US

IV. Provider business mailing address

9606 NE ZAC LENTZ PKWY
VICTORIA TX
77904-3115
US

V. Phone/Fax

Practice location:
  • Phone: 361-552-5400
  • Fax: 361-552-5406
Mailing address:
  • Phone: 361-582-2110
  • Fax: 361-541-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRIS STEFKA
Title or Position: ADMINISTRATOR
Credential: BS,PTA
Phone: 361-582-2110