MEDICARE: KALOS REHABILITATION, L.L.C.

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	225400000X	Rehabilitation Practitioner	F4113	TX

General Provider Information

NPI Number	:	1982615241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALOS REHABILITATION, L.L.C.

Provider Business Mailing Address
First Line	:	4127 S DANVILLE DR
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79605-7230
Country	:	US
Telephone Number	:	325-232-7005
Fax Number	:	325-232-7009

Provider Business Practice Location Address
First Line	:	4127 S DANVILLE DR
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79605-7230
Country	:	US
Telephone Number	:	325-232-7005
Fax Number	:	325-232-7009

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. S. JEFFERY JACKSON
Credential	:	MD
Telephone Number	:	325-232-7005

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/22/2020

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