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General NPI Number Information
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NPI Number | 1447687918
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Entity Type | Organization
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Legal Business Name | IMPRINTS REHABILITATION LLC
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 5111 N 10TH ST # 255
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City | MCALLEN
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State | TX
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Zip | 78504-2835
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Country | US
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Telephone | 210-723-6991
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Fax | 866-841-1303
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Provider Business Mailing Address
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Address Line | 5111 N 10TH ST # 255
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City | MCALLEN
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State | TX
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Zip | 78504-2835
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Country | US
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Telephone | 210-723-6991
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Fax | 866-841-1303
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Authorized Official
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Title or Position | OWNER
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Name | JACK RUELAS
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Credential | OTR
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Telephone | 210-723-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 113117
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 101342
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1152056
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License Number State | TX
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