Provider Demographics
NPI:1811374077
Name:NM REHAB & WELLNESS CENTER
Entity Type:Organization
Organization Name:NM REHAB & WELLNESS CENTER
Other - Org Name:NM REHAB & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:B
Authorized Official - Middle Name:
Authorized Official - Last Name:P
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-764-0759
Mailing Address - Street 1:2220 COIT ROAD
Mailing Address - Street 2:SUITE 480 - 203
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5773
Mailing Address - Country:US
Mailing Address - Phone:214-764-0759
Mailing Address - Fax:
Practice Address - Street 1:3620 N JOSEY LN STE 118
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3139
Practice Address - Country:US
Practice Address - Phone:214-764-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677930000OtherSTATE LICENSE