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General NPI Number Information
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NPI Number | 1982806634
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Entity Type | Organization
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Legal Business Name | REATA REHABILITATION
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9204 T N SKILES RD
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City | PONDER
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State | TX
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Zip | 76259-5819
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Country | US
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Telephone | 940-479-2612
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Fax |
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Provider Business Mailing Address
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Address Line | 9204 T N SKILES RD
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City | PONDER
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State | TX
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Zip | 76259-5819
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Country | US
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Telephone | 940-479-2612
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BECCA GLASER
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Credential | OTR
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Telephone | 940-479-2612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | TX
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