Basic Information
| Provider Information | |||||||||
| NPI: | 1811197155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RYKE REHABILITATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3875 E SOUTHCROSS BLVD | ||||||||
| Address2: | STE. B | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782223521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103377953 | ||||||||
| FaxNumber: | 2103377966 | ||||||||
| Practice Location | |||||||||
| Address1: | 12315 JUDSON RD | ||||||||
| Address2: | 200 | ||||||||
| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782333277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106567953 | ||||||||
| FaxNumber: | 2106567957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCARTHUR | ||||||||
| AuthorizedOfficialFirstName: | DUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | ALLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | BUISNESS OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2103377953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00974X | 01 | TX | MEDICARE GROUP PTAN NUMBE | OTHER |