Provider Demographics
NPI:1558825042
Name:TEXAS WHOLE BODY RECOVERY LLC
Entity Type:Organization
Organization Name:TEXAS WHOLE BODY RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DURANCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:817-442-9424
Mailing Address - Street 1:6100 COLLEYVILLE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8025
Mailing Address - Country:US
Mailing Address - Phone:817-442-9424
Mailing Address - Fax:
Practice Address - Street 1:6100 COLLEYVILLE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8025
Practice Address - Country:US
Practice Address - Phone:817-442-9424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty