Custom Rehab of South Texas, Inc.

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

CUSTOM REHAB OF SOUTH TEXAS, INC.

Practice address

12907 Highway 36
Needville, TX 77461

Phone

(979) 793-7570

Fax

(979) 793-5540

NPI assigned

Jan 22, 2007

Last updated

Jul 7, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lorena Matthiesen

Title

President

Phone

(979) 793-7570

Specialties & licenses 2

Addresses

Other identifiers 4

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Raymond Matthiesen

  • Other Technician
  • Needville, TX
  • NPI 1154618866
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1700930633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 467",
            "city": "NEEDVILLE",
            "state": "TX",
            "postal_code": "774610467",
            "telephone_number": "979-793-7570",
            "fax_number": "979-793-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12907 HIGHWAY 36",
            "city": "NEEDVILLE",
            "state": "TX",
            "postal_code": "77461",
            "telephone_number": "979-793-7570",
            "fax_number": "979-793-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM REHAB OF SOUTH TEXAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "MATTHIESEN",
        "authorized_official_first_name": "LORENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-793-7570",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011390401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP PROVIDER #",
            "identifier": "10023796",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "519066",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010008301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Brown, RN
• Paige Cahill, FNP-C
• Sherry Cardinal, LCSW
• Chalom Ranch Equine Assisted Therapy & Learning
• Donald T Cooper, M.A., LPC, NCC
• D&S Health and Wellness PLLC
• Liliana De Los Santos
• Courtney Deadman
• Angel C'Hara Edwards, LCSW
• Michele Elizondo, FNP

• Customized Equipment (DME) in Needville, TX
• Providers in Needville, TX by specialty
• Customized Equipment (DME) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.