Healthcare Provider Details

I. General information

NPI: 1497997019
Provider Name (Legal Business Name): A PLUS PEDIATRIC REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 08/02/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 CONSOLE DRIVE SUITE 102
SAN ANTONIO TX
78229-2042
US

IV. Provider business mailing address

9514 CONSOLE DRIVE SUITE 102
SAN ANTONIO TX
78229-2042
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax: 210-308-9595
Mailing address:
  • Phone: 210-448-9111
  • Fax: 210-308-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number663890000
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMED GHANNAM
Title or Position: CEO
Credential:
Phone: 210-448-9111