Provider Demographics
NPI: | 1710316997 |
---|---|
Name: | REHABILITATION MEDICINE CONSULTANTS PLLC |
Entity Type: | Organization |
Organization Name: | REHABILITATION MEDICINE CONSULTANTS PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | BENJAMIN |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | AGANA |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 281-419-3366 |
Mailing Address - Street 1: | PO BOX 8945 |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRING |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77387-8945 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 281-419-3366 |
Mailing Address - Fax: | 281-419-2233 |
Practice Address - Street 1: | 24727 TOMBALL PKWY |
Practice Address - Street 2: | |
Practice Address - City: | TOMBALL |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77375-7877 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-419-3366 |
Practice Address - Fax: | 281-419-2233 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-11-07 |
Last Update Date: | 2013-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Single Specialty |