=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124357801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XANADU REHABILITATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2009
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 FM 967 STE A
-----------------------------------------------------
City | BUDA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78610-2884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-295-2273
-----------------------------------------------------
Fax | 512-295-2280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1750 FM 967 # A
-----------------------------------------------------
City | BUDA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78610-3461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-295-2273
-----------------------------------------------------
Fax | 512-295-2280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MS. AMY GRANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-295-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 24694
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------