| Organization Name: | LAGUNA MADRE REHABILITATION CENTER |
| NPI Number: | 1841399623 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDY LEE PLATTNER (ADMINISTRATOR/OWNER) |
| Mailing Address: | 1200 State Highway 100 Ste 9 Port Isabel |
| State: | TX US |
| Postal Code: | 785782708 |
| Phone Number: | 9569432248 |
| Fax Number: | 9569434459 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 08/21/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |