NPIMap

Organization Active NPI

Providence Rehabilitation Services, LLC

  • Pediatric Physical Therapist
  • Mission, TX
National Provider Identifier
1811087166
Registry record updated Aug 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
Legal business name
PROVIDENCE REHABILITATION SERVICES, LLC
Practice address
1609 E Griffin Pkwy
Suite B
Mission, TX 78572-3101
Phone
(956) 424-1089
Fax
(956) 424-1090
NPI assigned
Oct 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2007

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

Authorized official

Name
Ruby Bocanegra
Title
President
Phone
(956) 424-1089

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251P0200X Primary
Physical Therapy Clinic/Center 261QP2000X 657030000 TX
Rehabilitation Clinic/Center 261QR0400X 657030000 TX

Addresses

Primary practice location

1609 E Griffin Pkwy
Suite B
Mission, TX 78572-3101

Mailing address

1609 E Griffin Pkwy
Suite B
Mission, TX 78572-3101
Phone (956) 424-1089

Other identifiers 2

IdentifierTypeStateIssuer
554300000OtherTXTX BOARD OF OCCU THERAPY
657030000OtherTXTX BOARD OF PHYS THERAPY

Other names 1

  • Providence Rehabilitation Services Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186012800000",
    "number": "1811087166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 E GRIFFIN PKWY",
            "address_2": "SUITE B",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785723101",
            "telephone_number": "956-424-1089",
            "fax_number": "956-424-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 E GRIFFIN PKWY",
            "address_2": "SUITE B",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "785723101",
            "telephone_number": "956-424-1089",
            "fax_number": "956-424-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE REHABILITATION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-14",
        "last_updated": "2007-08-02",
        "status": "A",
        "authorized_official_last_name": "BOCANEGRA",
        "authorized_official_first_name": "RUBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "956-424-1089"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TX",
            "license": "657030000",
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "TX",
            "license": "657030000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX BOARD OF OCCU THERAPY",
            "identifier": "554300000",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX BOARD OF PHYS THERAPY",
            "identifier": "657030000",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Rehabilitation Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mission, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2007; 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.