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NPI Code Detail

MEDICARE: DORA ROBERTS REHABILITATION CENTER

MEDICARE: DORA ROBERTS REHABILITATION CENTER
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
1261QR0400XRehabilitation Clinic/CenterTX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100L09GOTHERTXMEDICARE B

General Provider Information

NPI Number : 1760486708
Entity Type Code : Organization
Provider Name (Legal Business Name) : DORA ROBERTS REHABILITATION CENTER
Provider Business Mailing Address
First Line : 306 W 3RD ST
Second Line :
City : BIG SPRING
State : TX
Zip : 79720-2429
Country : US
Telephone Number : 432-267-3806
Fax Number : 432-267-3809
Provider Business Practice Location Address
First Line : 306 W 3RD ST
Second Line :
City : BIG SPRING
State : TX
Zip : 79720-2429
Country : US
Telephone Number : 432-267-3806
Fax Number : 432-267-3809
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : PENNY PHILLIPS
Credential :
Telephone Number : 432-267-3806
Provider Enumeration Date : 06/08/2005
Last Update Date : 08/22/2020

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Practice Location Address:
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1356433007 — MR. JASON T SIMS P.T.
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79720-2429
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1982797767 — MR. TOBY C KEEL P.T.A.
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1407949290 — MRS. SUSAN R HENDERSON C.O.T.A.
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Directions to “DORA ROBERTS REHABILITATION CENTER ” Practice Location

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