Healthcare Provider Details

I. General information

NPI: 1720292535
Provider Name (Legal Business Name): PHYSICAL REHABILITATION HOSPITAL OF WHARTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGHWAY 59 LOOP N
WHARTON TX
77488-7807
US

IV. Provider business mailing address

2014 W PINHOOK RD SUITE 404
LAFAYETTE LA
70508-8504
US

V. Phone/Fax

Practice location:
  • Phone: 337-264-8121
  • Fax: 337-264-8194
Mailing address:
  • Phone: 337-264-8121
  • Fax: 337-264-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MARK J HARRIS
Title or Position: CEO
Credential:
Phone: 337-264-8121