Custom Rehab of South Texas, Inc.
Organization Active NPI Customized Equipment (DME) · Needville, TX
NPI 1700930633 · NPPES record last updated Jul 7, 2011
Key facts
- NPI
- 1700930633
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Customized Equipment (DME) 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
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lorena Matthiesen
- Title
- President
- Phone
- (979) 793-7570
Practitioners 1
National Provider Directory
Locations
12907 Highway 36
Needville, TX 77461
Phone (979) 793-7570
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Customized Equipment (DME) | 332BC3200X | Yes |
Addresses
Primary practice location
12907 Highway 36
Needville, TX 77461
Mailing address
PO Box 467
Needville, TX 77461-0467
Phone (979) 793-7570
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10023796 | Other | TX | AMERIGROUP PROVIDER # |
| 519066 | Other | TX | BLUE CROSS BLUE SHIELD |
| 010008301 | Medicaid | TX | |
| 011390401 | Medicaid | TX |
Other providers in Needville, TX
- Lisa Marie Brown
- Paige Cahill
- Sherry Cardinal
- Chalom Ranch Equine Assisted Therapy & Learning
- Donald T Cooper
- Liliana De Los Santos
- Courtney Deadman
- Angel C'Hara Edwards
- Michele Elizondo
- Alana Rose Elolf
All providers in Needville, TX · Customized Equipment (DME) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.