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NPI Code Detail

MEDICARE: PRODUCTIVE REHAB GROUP

MEDICARE: PRODUCTIVE REHAB GROUP
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
1314000000XSkilled Nursing Facility2042778TX

General Provider Information

NPI Number : 1881839629
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRODUCTIVE REHAB GROUP
Provider Business Mailing Address
First Line : PO BOX 300967
Second Line :
City : HOUSTON
State : TX
Zip : 77230-0967
Country : US
Telephone Number : 210-386-9936
Fax Number :
Provider Business Practice Location Address
First Line : 5033 KENTON ROYALLE
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78240-1559
Country : US
Telephone Number : 210-386-9936
Fax Number :
Authorized Official
Title or Position : P.T.A.
Name : MR. DEVAUGHN VINSON
Credential :
Telephone Number : 210-386-9936
Provider Enumeration Date : 12/08/2008
Last Update Date : 12/08/2008

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