Provider Demographics
NPI:1942751748
Name:TEXOMA REHAB PLLC
Entity Type:Organization
Organization Name:TEXOMA REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:UMU-KULTHUM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-MAAWY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-533-7124
Mailing Address - Street 1:3901 ARMORY RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 ARMORY RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2204
Practice Address - Country:US
Practice Address - Phone:940-720-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9105283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1619310661OtherPIN