Provider Demographics
NPI:1114947587
Name:REHABILITATION TREATMENT PA
Entity Type:Organization
Organization Name:REHABILITATION TREATMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-562-1388
Mailing Address - Street 1:PO BOX 678397
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8397
Mailing Address - Country:US
Mailing Address - Phone:972-562-1388
Mailing Address - Fax:972-562-1344
Practice Address - Street 1:1441 REDBUD BLVD
Practice Address - Street 2:SUITE 261
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:972-562-1388
Practice Address - Fax:972-562-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3253208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155651601Medicaid
TXDF4734Medicare PIN
TX00613VMedicare PIN
TX00W910Medicare PIN