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	650970009	TX

General Provider Information

NPI Number	:	1417995416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX REHABILITATION- TEXAS, INC.

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8526 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2103
Country	:	US
Telephone Number	:	281-550-5656
Fax Number	:	281-550-7496

Authorized Official
Title or Position	:	VICE PRESIDENT AND SECRETARY
Name	:	MICHAEL E TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	10/29/2018

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