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General NPI Number Information
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NPI Number | 1093716078
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE REHAB, LLC
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 101 W HILLSIDE RD STE 6-B
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City | LAREDO
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State | TX
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Zip | 78041-3141
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Country | US
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Telephone | 956-725-5212
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Fax | 956-796-1117
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Provider Business Mailing Address
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Address Line | 101 W HILLSIDE RD STE 6-B
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City | LAREDO
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State | TX
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Zip | 78041-3141
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Country | US
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Telephone | 956-725-5212
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Fax | 956-796-1117
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. CYNTHIA INFANTE
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Credential |
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Telephone | 956-725-5212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1056653
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License Number State | TX
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