Basic Information
Provider Information | |||||||||
NPI: | 1245430586 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RYKE REHABILITATION, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3875 E SOUTHCROSS BLVD | ||||||||
Address2: | STE. B | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782223521 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2103377953 | ||||||||
FaxNumber: | 2103377966 | ||||||||
Practice Location | |||||||||
Address1: | 3110 NOGALITOS | ||||||||
Address2: | STE. 201 | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782252336 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2105347953 | ||||||||
FaxNumber: | 2105346695 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/24/2007 | ||||||||
LastUpdateDate: | 07/24/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MCARTHUR | ||||||||
AuthorizedOfficialFirstName: | DUSTIN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BUISNESS OWNER | ||||||||
AuthorizedOfficialTelephone: | 2103377953 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 00974X | 01 | TX | GROUP MEDICARE PTAN NUMBE | OTHER |