MEDICARE: THERAPY PLANET REHAB SERVICES

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	:	1265191613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY PLANET REHAB SERVICES

Provider Business Mailing Address
First Line	:	1817 WAYNE DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78542-5558
Country	:	US
Telephone Number	:	956-454-1168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 WAYNE DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78542-5558
Country	:	US
Telephone Number	:	956-454-1168
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARCIA LYNN GONZALEZ
Credential	:	M.A., CCC/SLP
Telephone Number	:	956-454-1168

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/13/2023

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