Provider Demographics
NPI:1821280843
Name:CONROE PHYSICAL MEDICINE AND REHABILITATION PA
Entity Type:Organization
Organization Name:CONROE PHYSICAL MEDICINE AND REHABILITATION PA
Other - Org Name:APEX PHYSICAL MEDICINE AND REHAB.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:PHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-494-2010
Mailing Address - Street 1:690 S LOOP 336 W
Mailing Address - Street 2:STE 240
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3320
Mailing Address - Country:US
Mailing Address - Phone:936-494-2010
Mailing Address - Fax:936-494-2012
Practice Address - Street 1:690 S LOOP 336 W
Practice Address - Street 2:STE 240
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3320
Practice Address - Country:US
Practice Address - Phone:936-494-2010
Practice Address - Fax:936-494-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty