Provider Demographics
NPI:1508972738
Name:HEALTHPRIME REHABILITATION & PAINCARE SPECIALIST, INC.
Entity Type:Organization
Organization Name:HEALTHPRIME REHABILITATION & PAINCARE SPECIALIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ZONIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VELAZCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-357-3988
Mailing Address - Street 1:3198 ROYAL LN
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3777
Mailing Address - Country:US
Mailing Address - Phone:214-357-3988
Mailing Address - Fax:214-357-0679
Practice Address - Street 1:3198 ROYAL LN
Practice Address - Street 2:SUITE 107
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-3777
Practice Address - Country:US
Practice Address - Phone:214-357-3988
Practice Address - Fax:214-357-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45-4578Medicare ID - Type UnspecifiedCORF