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General NPI Number Information
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NPI Number | 1629209606
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Entity Type | Organization
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Legal Business Name | ST. DAVID'S PHYSICAL MEDICINE AND REHABILITATION, PLLC
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 1015 E 32ND ST SUITE 306
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City | AUSTIN
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State | TX
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Zip | 78705-2707
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Country | US
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Telephone | 512-236-1310
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Fax | 512-236-6963
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Provider Business Mailing Address
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Address Line | 98 SAN JACINTO BLVD SUITE 1800
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City | AUSTIN
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State | TX
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Zip | 78701-4082
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Country | US
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Telephone | 512-708-9700
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Fax | 512-482-4191
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JOHN REBOK
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Credential |
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Telephone | 512-708-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number |
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License Number State |
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