=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114225398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DINO THERAPY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2011
-----------------------------------------------------
Last Update Date | 03/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1315 W MAIN AVE SUITE 11
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78573-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-997-4222
-----------------------------------------------------
Fax | 956-338-5785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6120 N SHARY RD
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78573-8333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-997-4222
-----------------------------------------------------
Fax | 956-338-5785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RENE MORALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-997-4222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------