Healthcare Provider Details

I. General information

NPI: 1487658050
Provider Name (Legal Business Name): RGV-NUECES REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD SUITE 465
SAN ANTONIO TX
78211-3758
US

IV. Provider business mailing address

PO BOX 1329
HELOTES TX
78023-1329
US

V. Phone/Fax

Practice location:
  • Phone: 210-921-2111
  • Fax: 210-921-2444
Mailing address:
  • Phone: 210-921-2111
  • Fax: 210-921-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number629340000
License Number StateTX

VIII. Authorized Official

Name: MR. PETER JOHN SCHANEN
Title or Position: OWNER/CEO
Credential:
Phone: 210-921-2111