1023295425 NPI number — TEKTONIC ATHLETIC DEVELOPMENT & REHABILITATION

Table of content: DR. MELISSA JILL SVEEN D.D.S. (NPI 1275523516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023295425 NPI number — TEKTONIC ATHLETIC DEVELOPMENT & REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEKTONIC ATHLETIC DEVELOPMENT & REHABILITATION
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:
Provider Other Organization Name Type Code:
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:
1023295425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1623 PINE OAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304-1337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-482-9635
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 PRUITT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-482-9635
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
ROBYNE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
832-482-9635

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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)





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