MEDICARE: WATERFALLS 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
1	261QP2000X	Physical Therapy Clinic/Center	6893	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6893	OTHER	TX	CHIROPRACTOR

General Provider Information

NPI Number	:	1831427186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERFALLS REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	3300 S GESSNER RD STE 246
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5140
Country	:	US
Telephone Number	:	832-767-2736
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 S GESSNER RD STE 246
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5140
Country	:	US
Telephone Number	:	832-767-2736
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLENDA MARITZA QUINTEROZ
Credential	:
Telephone Number	:	832-767-2736

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	11/25/2009

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