1003286329 NPI number — ADVANCED FUNCTIONAL REHAB

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003286329 NPI number — ADVANCED FUNCTIONAL REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED FUNCTIONAL REHAB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED FUNCTIONAL REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003286329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17424 W GRAND PKWY S
Provider Second Line Business Mailing Address:
SUITE 521
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-410-8750
Provider Business Mailing Address Fax Number:
281-709-6797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5959 WEST LOOP S
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77401-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-410-8750
Provider Business Practice Location Address Fax Number:
281-709-6797
Provider Enumeration Date:
09/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON-WIGGINS
Authorized Official First Name:
PLESHETTE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
281-410-8750

Provider Taxonomy Codes

  • Taxonomy code: 111NX0100X , with the licence number:  9316 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com