Provider Demographics
NPI:1629568563
Name:APOLLO REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:APOLLO REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ILIANA
Authorized Official - Middle Name:MEDINA
Authorized Official - Last Name:CHANDARLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:956-568-9812
Mailing Address - Street 1:1420 CEDAR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-7956
Mailing Address - Country:US
Mailing Address - Phone:956-568-9812
Mailing Address - Fax:956-568-9813
Practice Address - Street 1:1420 CEDAR AVE STE A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-7956
Practice Address - Country:US
Practice Address - Phone:956-568-9812
Practice Address - Fax:956-568-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1155739OtherPHYSICAL THERAPY