Provider Demographics
NPI:1992192512
Name:BAYLOR INSTITUTE FOR REHABILITATION
Entity Type:Organization
Organization Name:BAYLOR INSTITUTE FOR REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:512-657-5104
Mailing Address - Street 1:4347 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-3864
Mailing Address - Country:US
Mailing Address - Phone:214-654-0947
Mailing Address - Fax:214-654-0956
Practice Address - Street 1:4347 W NORTHWEST HWY
Practice Address - Street 2:SUITE 180
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3864
Practice Address - Country:US
Practice Address - Phone:214-654-0947
Practice Address - Fax:214-654-0956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELECT MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1203197283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital