Provider Demographics
NPI:1548414170
Name:ANVIK REHAB CENTER, ONC.
Entity Type:Organization
Organization Name:ANVIK REHAB CENTER, ONC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOLMAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:972-612-5363
Mailing Address - Street 1:4152 W SPRING CREEK PKWY STE 116
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5315
Mailing Address - Country:US
Mailing Address - Phone:972-612-5363
Mailing Address - Fax:972-612-5782
Practice Address - Street 1:4152 W SPRING CREEK PKWY STE 116
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5315
Practice Address - Country:US
Practice Address - Phone:972-612-5363
Practice Address - Fax:972-612-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9753111N00000X
225100000X, 2251X0800X, 2255A2300X, 225700000X, 225C00000X, 225XP0019X, 226300000X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Single Specialty
No283X00000XHospitalsRehabilitation HospitalGroup - Single Specialty