Provider Demographics
NPI:1508899048
Name:STARLIGHT MEDICAL & REHAB CLINIC, INC.
Entity Type:Organization
Organization Name:STARLIGHT MEDICAL & REHAB CLINIC, INC.
Other - Org Name:STARLIGHT MEDICAL & REHAB CLINIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:JAGO
Authorized Official - Last Name:PATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-303-7158
Mailing Address - Street 1:10103 FONDREN RD
Mailing Address - Street 2:353
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4556
Mailing Address - Country:US
Mailing Address - Phone:713-777-6060
Mailing Address - Fax:713-777-6063
Practice Address - Street 1:10103 FONDREN RD
Practice Address - Street 2:353
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4556
Practice Address - Country:US
Practice Address - Phone:713-777-6060
Practice Address - Fax:713-777-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2794225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W211Medicare ID - Type UnspecifiedPHYSICAL THERAPY CLINIC