Provider Demographics
NPI:1578221511
Name:REHABMD LLC
Entity Type:Organization
Organization Name:REHABMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IOANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORFIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:312-451-5976
Mailing Address - Street 1:2805 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5619
Mailing Address - Country:US
Mailing Address - Phone:312-451-5976
Mailing Address - Fax:
Practice Address - Street 1:601 S CLAY ST STE 104
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5771
Practice Address - Country:US
Practice Address - Phone:214-461-0543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies