MEDICARE: FIRST COLONY REHAB, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1720028459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COLONY REHAB, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3106
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77552-0106
Country	:	US
Telephone Number	:	409-741-8472
Fax Number	:	409-741-2342

Provider Business Practice Location Address
First Line	:	6444 CENTRAL CITY BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77551-2058
Country	:	US
Telephone Number	:	409-741-8472
Fax Number	:	409-741-2342

Authorized Official
Title or Position	:	OWNER
Name	:	KENDALL GILL
Credential	:	PT
Telephone Number	:	817-929-1420

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/10/2021

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