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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