Organization
1810 BLDG., LTD.
Active
Other names
Mid Valley Physical Therapy and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER R HEREDIA MD (GENERAL PARTNER)
(956) 968-9392
Entity
Organization
Contact information
Practice address
1810 E 8TH ST, WESLACO, TX 78596-6648
(956) 968-9392
(956) 968-5722
Mailing address
1810 E 8TH ST, WESLACO, TX 78596-6648
(956) 968-9392
(956) 968-5722
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
553070000
TX
261QR0400X
Rehabilitation Clinic/Center
640450000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000028EX
BCBS
TX
05
—
157355201
—
TX
Enumeration date
12/28/2005
Last updated
06/17/2008
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