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General NPI Number Information
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NPI Number | 1780752105
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Entity Type | Organization
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Legal Business Name | SUPERKIDS REHABILITATION INC.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 4430 E 14TH ST SUITE E
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City | BROWNSVILLE
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State | TX
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Zip | 78521-3363
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Country | US
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Telephone | 956-831-7600
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Fax | 956-831-0386
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Provider Business Mailing Address
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Address Line | 4430 E 14TH ST SUITE E
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City | BROWNSVILLE
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State | TX
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Zip | 78521-3363
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Country | US
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Telephone | 956-831-7600
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Fax | 956-831-0386
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK W. BAILEY
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Credential | D.C.
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Telephone | 956-831-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 552160000
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License Number State | TX
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