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General NPI Number Information
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NPI Number | 1962495580
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Entity Type | Organization
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Legal Business Name | MISSION REHABILITATION SERVICES
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 1901 W LOOP 289 SUITE 3
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City | LUBBOCK
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State | TX
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Zip | 79407-1713
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Country | US
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Telephone | 806-792-7125
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Fax | 806-792-7121
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Provider Business Mailing Address
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Address Line | 1901 W LOOP 289 SUITE 3
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City | LUBBOCK
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State | TX
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Zip | 79407-1713
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Country | US
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Telephone | 806-792-7125
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Fax | 806-792-7121
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Authorized Official
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Title or Position | OWNER / PHYSICAL THERAPIST
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Name | CECILIA MITCHELL
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Credential | PT
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Telephone | 806-792-7125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 629990000
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License Number State | TX
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