Provider Demographics
NPI:1558554402
Name:HOUSTON REHABILITATION SPECIALIST, P.A.
Entity Type:Organization
Organization Name:HOUSTON REHABILITATION SPECIALIST, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIQUE
Authorized Official - Middle Name:LYSANNE
Authorized Official - Last Name:VANDONGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-505-3526
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77492-0520
Mailing Address - Country:US
Mailing Address - Phone:281-505-3526
Mailing Address - Fax:281-505-3895
Practice Address - Street 1:23331 GRAND RESERVE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4850
Practice Address - Country:US
Practice Address - Phone:281-505-3500
Practice Address - Fax:281-505-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty