Provider Demographics
NPI:1285858001
Name:TEAM CONCEPT REHABILITATION LLC
Entity Type:Organization
Organization Name:TEAM CONCEPT REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-772-8766
Mailing Address - Street 1:1123 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4217
Mailing Address - Country:US
Mailing Address - Phone:972-772-8766
Mailing Address - Fax:972-772-8833
Practice Address - Street 1:1123 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4217
Practice Address - Country:US
Practice Address - Phone:972-772-8766
Practice Address - Fax:972-772-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609567Medicare ID - Type UnspecifiedMEDICARE NUMBER