MEDICARE: THERAPY EXPRESS CHILDREN'S REHABILITATION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1013268457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY EXPRESS CHILDREN'S REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	302 E US HIGHWAY 83
Second Line	:	STE 12
City	:	SAN JUAN
State	:	TX
Zip	:	78589-2900
Country	:	US
Telephone Number	:	956-457-3622
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 E US HIGHWAY 83
Second Line	:	STE 12
City	:	SAN JUAN
State	:	TX
Zip	:	78589-2900
Country	:	US
Telephone Number	:	956-457-3622
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANGELA TREVINO
Credential	:
Telephone Number	:	956-457-3622

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	09/27/2012

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