Provider Demographics
NPI:1679022404
Name:TEXOMA REHAB PLLC
Entity Type:Organization
Organization Name:TEXOMA REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:UMU-KULTHUM
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:AL-MAAWY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:940-720-5700
Mailing Address - Street 1:3901 ARMORY RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2204
Mailing Address - Country:US
Mailing Address - Phone:940-720-5700
Mailing Address - Fax:940-720-5765
Practice Address - Street 1:3901 ARMORY RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2204
Practice Address - Country:US
Practice Address - Phone:940-720-5700
Practice Address - Fax:940-720-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty