Provider Demographics
NPI:1003286329
Name:ADVANCED FUNCTIONAL REHAB
Entity Type:Organization
Organization Name:ADVANCED FUNCTIONAL REHAB
Other - Org Name:ADVANCED FUNCTIONAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PLESHETTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHNSON-WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-410-8750
Mailing Address - Street 1:17424 W GRAND PKWY S
Mailing Address - Street 2:SUITE 521
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2564
Mailing Address - Country:US
Mailing Address - Phone:281-410-8750
Mailing Address - Fax:281-709-6797
Practice Address - Street 1:5959 WEST LOOP S
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2421
Practice Address - Country:US
Practice Address - Phone:281-410-8750
Practice Address - Fax:281-709-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9316111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty