Provider Demographics
NPI:1619037629
Name:EAGLE WARD REHABILITATION, INC
Entity type:Organization
Organization Name:EAGLE WARD REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:EAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-258-5300
Mailing Address - Street 1:9707 ANDERSON MILL RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3227
Mailing Address - Country:US
Mailing Address - Phone:512-258-5300
Mailing Address - Fax:512-258-4475
Practice Address - Street 1:9707 ANDERSON MILL RD.
Practice Address - Street 2:SUITE 340
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3227
Practice Address - Country:US
Practice Address - Phone:512-258-5300
Practice Address - Fax:512-258-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX625280002261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00051XMedicare ID - Type Unspecified