Provider Demographics
NPI:1033355144
Name:SPINAL REHABILITATION ASSOCIATES RLLP
Entity Type:Organization
Organization Name:SPINAL REHABILITATION ASSOCIATES RLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:214-530-8400
Mailing Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3566
Mailing Address - Country:US
Mailing Address - Phone:214-530-8400
Mailing Address - Fax:214-691-2967
Practice Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3566
Practice Address - Country:US
Practice Address - Phone:214-691-2975
Practice Address - Fax:214-691-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3516Medicare PIN
TX0A3517Medicare PIN
TX0A3515Medicare PIN