MEDICARE: CREATIONS THERAPY OUTPATIENT REHAB LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1427682152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIONS THERAPY OUTPATIENT REHAB LLC

Provider Business Mailing Address
First Line	:	200 E INTERSTATE 2 STE H
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-6506
Country	:	US
Telephone Number	:	956-651-5023
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E INTERSTATE 2 STE H
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-6506
Country	:	US
Telephone Number	:	956-651-5023
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHANNON MCLAUGHLIN
Credential	:	OT
Telephone Number	:	956-651-5023

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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