Provider Demographics
NPI:1467999599
Name:TEXAS INSTITUTE FOR PHYSICAL MEDICINE AND REHABILITATION
Entity Type:Organization
Organization Name:TEXAS INSTITUTE FOR PHYSICAL MEDICINE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DESI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-7881
Mailing Address - Street 1:7515 GREENVILLE AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3831
Mailing Address - Country:US
Mailing Address - Phone:214-369-7881
Mailing Address - Fax:214-369-7882
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3831
Practice Address - Country:US
Practice Address - Phone:214-369-7881
Practice Address - Fax:214-369-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5042208100000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1023210473Medicare NSC