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General NPI Number Information
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NPI Number | 1639262264
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Entity Type | Organization
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Legal Business Name | TEXAS REGIONAL EDEMA LYMPHEDEMA AND WOUND CARE CENTER LLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1232 BANDERA HWY.
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City | KERRVILLE
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State | TX
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Zip | 78028
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Country | US
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Telephone | 830-257-9770
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Fax | 830-257-9760
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Provider Business Mailing Address
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Address Line | P. O. BOX 291922
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City | KERRVILLE
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State | TX
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Zip | 78029-1922
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Country | US
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Telephone | 830-257-9770
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Fax | 830-257-9760
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Authorized Official
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Title or Position | C.E.O.
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Name | MRS. CAROLYN J. BAILEY
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Credential |
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Telephone | 830-257-9770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | TX
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