Organization
TEAM REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRISCELLA STEPHENS (OWNER)
(361) 552-5400
Entity
Organization
Contact information
Practice address
300 N VIRGINIA ST, PORT LAVACA, TX 77979-3433
(361) 552-5400
(361) 552-5406
Mailing address
300 N VIRGINIA ST, PORT LAVACA, TX 77979-3433
(361) 552-5400
(361) 552-5406
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
676250000
FACILITY REGISTRATION
TX
Enumeration date
01/09/2015
Last updated
01/09/2015
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