Provider Demographics
NPI:1730121153
Name:CORPUS CHRISTI INSTITUTE OF PAIN MANAGEMENT INC
Entity Type:Organization
Organization Name:CORPUS CHRISTI INSTITUTE OF PAIN MANAGEMENT INC
Other - Org Name:REHAB ONE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGEMENT CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:EVAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-549-3798
Mailing Address - Street 1:6001 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2901
Mailing Address - Country:US
Mailing Address - Phone:361-993-3917
Mailing Address - Fax:361-993-4336
Practice Address - Street 1:6001 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2901
Practice Address - Country:US
Practice Address - Phone:361-993-3917
Practice Address - Fax:361-993-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3033DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042GHOtherBC/BS GROUP
TX0042GHOtherBC/BS GROUP
TXUT14651Medicare UPIN