Provider Demographics
NPI:1902195373
Name:TOTAL RECOVERY PHYSICAL MODALITY, PC
Entity Type:Organization
Organization Name:TOTAL RECOVERY PHYSICAL MODALITY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-325-9508
Mailing Address - Street 1:3007 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-2822
Mailing Address - Country:US
Mailing Address - Phone:214-325-9508
Mailing Address - Fax:713-533-1408
Practice Address - Street 1:3007 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2822
Practice Address - Country:US
Practice Address - Phone:214-325-9508
Practice Address - Fax:713-533-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5571173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty