MEDICARE: MATRIX REHABILITATION -TEXAS, INC.

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	:	1275572174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX REHABILITATION -TEXAS, INC.

Provider Business Mailing Address
First Line	:	335 ROSELANE ST NW
Second Line	:	SUITE 201
City	:	MARIETTA
State	:	GA
Zip	:	30060-7902
Country	:	US
Telephone Number	:	470-259-5226
Fax Number	:	267-321-2044

Provider Business Practice Location Address
First Line	:	4701 W PARKER RD
Second Line	:	SUITE 625
City	:	PLANO
State	:	TX
Zip	:	75093-3376
Country	:	US
Telephone Number	:	972-398-2555
Fax Number	:	972-398-9003

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	CYNTHIA L. GOLDBERG
Credential	:
Telephone Number	:	610-644-7824

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/04/2015

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