Provider Demographics
NPI:1154512168
Name:FUNCTIONAL RESTORATION SERVICES OF TEXAS, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL RESTORATION SERVICES OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:BODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-962-4377
Mailing Address - Street 1:11275 S SAM HOUSTON PKWY W
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-2357
Mailing Address - Country:US
Mailing Address - Phone:832-328-4545
Mailing Address - Fax:832-328-4548
Practice Address - Street 1:11275 S SAM HOUSTON PKWY W
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-2357
Practice Address - Country:US
Practice Address - Phone:832-328-4545
Practice Address - Fax:832-328-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty