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General NPI Number Information
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NPI Number | 1225273253
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH AND REHABILITATION CENTRE PC
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 2013 WELLS BRANCH PKWY # 103
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City | AUSTIN
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State | TX
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Zip | 78728-6903
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Country | US
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Telephone | 512-835-6077
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Fax | 512-835-6079
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Provider Business Mailing Address
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Address Line | 2013 WELLS BRANCH PKWY # 103
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City | AUSTIN
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State | TX
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Zip | 78728-6903
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Country | US
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Telephone | 512-835-6077
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Fax | 512-835-6079
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. MARK CHARLES LESKO
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Credential | D.C.
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Telephone | 512-835-6077
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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 | 1178892
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4597
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License Number State | TX
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