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General NPI Number Information
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NPI Number | 1881839629
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Entity Type | Organization
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Legal Business Name | PRODUCTIVE REHAB GROUP
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Dates
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Enumeration Date | 12/08/2008
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Last Update Date | 12/08/2008
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Provider Practice Location Address
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Address Line | 5033 KENTON ROYALLE
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1559
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Country | US
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Telephone | 210-386-9936
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 300967
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City | HOUSTON
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State | TX
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Zip | 77230-0967
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Country | US
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Telephone | 210-386-9936
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Fax |
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Authorized Official
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Title or Position | P.T.A.
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Name | MR. DEVAUGHN VINSON
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Credential |
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Telephone | 210-386-9936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2042778
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License Number State | TX
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