Organization
PROVIDENCE REHABILITATION SERVICES, LLC
Active
Organization
PROVIDENCE REHABILITATION SERVICES, LLC
Active
Other names
Providence Rehabilitation Services
Organization subpart
No
Provider details
NPI number
Authorized official
RUBY BOCANEGRA (PRESIDENT)
(956) 424-1089
Entity
Organization
Contact information
Practice address
1609 E GRIFFIN PKWY, SUITE B, MISSION, TX 78572-3101
(956) 424-1089
(956) 424-1090
Mailing address
1609 E GRIFFIN PKWY, SUITE B, MISSION, TX 78572-3101
(956) 424-1089
(956) 424-1090
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
657030000
TX
261QR0400X
Rehabilitation Clinic/Center
657030000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
554300000
TX BOARD OF OCCU THERAPY
TX
01
—
657030000
TX BOARD OF PHYS THERAPY
TX
Enumeration date
10/14/2006
Last updated
08/02/2007
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