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General NPI Number Information
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NPI Number | 1831636869
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Entity Type | Organization
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Legal Business Name | MEDREHAB, LLC
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Dates
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Enumeration Date | 01/29/2017
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 2619 JONES RD STE C
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City | AUSTIN
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State | TX
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Zip | 78745-2682
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Country | US
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Telephone | 512-792-9501
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Fax | 512-792-9534
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Provider Business Mailing Address
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Address Line | 2619 JONES RD STE C
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City | AUSTIN
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State | TX
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Zip | 78745-2682
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Country | US
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Telephone | 512-792-9501
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Fax | 512-792-9534
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Authorized Official
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Title or Position | OWNER/CEO
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Name | GINA KAY STANGO
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Credential | OTR/L, OTD, MOT, ATP
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Telephone | 512-792-9501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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