Basic Information
| Provider Information | |||||||||
| NPI: | 1831158641 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHAB SPECIALTIES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 GRAND BLVD | ||||||||
| Address2: | B | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137911011 | ||||||||
| FaxNumber: | 7137911011 | ||||||||
| Practice Location | |||||||||
| Address1: | 7100 GRAND BLVD | ||||||||
| Address2: | B | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137911011 | ||||||||
| FaxNumber: | 7137911011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | HENDRICKSON | ||||||||
| AuthorizedOfficialFirstName: | JAIMIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7137911011 | ||||||||
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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 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 010432501 | 05 | TX | MEDICAID | 079450501 | 05 | TX | MEDICAID | 079450502 | 05 | TX | MEDICAID | 012007301 | 05 | TX | MEDICAID | 519844 | 01 | TX | BCBS | OTHER |