=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700551041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE REHAB PT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2021
-----------------------------------------------------
Last Update Date | 08/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3516 MORRIS ST
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78542-4574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-328-0811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3516 MORRIS ST
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78542-4574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-328-0811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MARIO G GARZA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 956-328-0811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------