Provider Demographics
NPI:1548540461
Name:ABILICARE THERAPY, PLLC
Entity type:Organization
Organization Name:ABILICARE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALSTEAD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-520-1723
Mailing Address - Street 1:PO BOX 681271
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-1271
Mailing Address - Country:US
Mailing Address - Phone:210-520-1723
Mailing Address - Fax:210-520-1724
Practice Address - Street 1:1201 N RAUL LONGORIA RD
Practice Address - Street 2:SUITE P
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3727
Practice Address - Country:US
Practice Address - Phone:210-520-1723
Practice Address - Fax:210-520-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562050001225X00000X
235Z00000X
TX669140001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty