=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063794485
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABILITATION THERAPY CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2011
-----------------------------------------------------
Last Update Date | 09/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17254 STEDMAN DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75252-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-407-0916
-----------------------------------------------------
Fax | 972-407-1370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 794994
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75379-4994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-407-0916
-----------------------------------------------------
Fax | 972-407-1370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MT/DIRECTOR
-----------------------------------------------------
Name | JACOB DOBRUSHKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-407-0916
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT007576
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------