Basic Information
| Provider Information | |||||||||
| NPI: | 1699734988 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHAB SPECIALTIES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 GRAND BLVD | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137911101 | ||||||||
| FaxNumber: | 7137911047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1868 W MOCKINGBIRD LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752355013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723239393 | ||||||||
| FaxNumber: | 9723239262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 11/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | LANCE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8323315710 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 017189403 | 05 | TX | MEDICAID | 10032272 | 01 | TX | AMERIGROUP | OTHER | 530596 | 01 | TX | BCBS | OTHER | 011137901 | 05 | TX | MEDICAID | 017189402 | 05 | TX | MEDICAID | 017189401 | 05 | TX | MEDICAID |