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General NPI Number Information
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NPI Number | 1043470461
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Entity Type | Organization
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Legal Business Name | JUMPSTART REHABILITATION SERVICES
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 28753 MCLELLAND RD
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City | HARLINGEN
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State | TX
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Zip | 78552-2226
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Country | US
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Telephone | 956-966-0158
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | SAN PERLITA
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State | TX
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Zip | 78590-0097
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER, DIETITIAN
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Name | AMANDA SHEWMAKER
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Credential | RD, LD
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Telephone | 956-966-0158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | DTO6832
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License Number State | TX
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