MEDICARE: REHAB CENTER, LLC

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	103TC0700X	Clinical Psychologist	25360	TX
2	225X00000X	Occupational Therapist	104540	TX
3	111NN0400X	Neurology Chiropractor	5539	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0020JN	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1245456540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB CENTER, LLC

Provider Business Mailing Address
First Line	:	18208 PRESTON RD
Second Line	:	SUITE D9320
City	:	DALLAS
State	:	TX
Zip	:	75252-6007
Country	:	US
Telephone Number	:	469-212-3261
Fax Number	:	214-484-5990

Provider Business Practice Location Address
First Line	:	5519 ARAPAHO ROAD
Second Line	:	SUITE 108
City	:	DALLAS
State	:	TX
Zip	:	75248
Country	:	US
Telephone Number	:	469-212-3261
Fax Number	:	214-484-5990

Authorized Official
Title or Position	:	LC MANAGER
Name	:	RANDAL FLOYD
Credential	:	OTAIDE
Telephone Number	:	469-212-3261

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	09/16/2011

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Directions to “REHAB CENTER, LLC ” Practice Location

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