Provider Demographics
NPI:1679054407
Name:PHYSICAL MEDICINE AND NEUROREHABILITATION PA
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE AND NEUROREHABILITATION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA VELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-907-2789
Mailing Address - Street 1:3024 BRIDLE PATH LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3057
Mailing Address - Country:US
Mailing Address - Phone:347-907-2789
Mailing Address - Fax:281-617-4242
Practice Address - Street 1:2121 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2153
Practice Address - Country:US
Practice Address - Phone:346-907-3000
Practice Address - Fax:346-907-3395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL MEDICINE AND NEUROREHABILITATION PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1177208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty