Provider Demographics
NPI:1265495816
Name:NEUROMUSCULOSKELETAL REHABILITATION MEDICINE CONSULTANT
Entity type:Organization
Organization Name:NEUROMUSCULOSKELETAL REHABILITATION MEDICINE CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-284-9850
Mailing Address - Street 1:7750 N MACARTHUR BLVD
Mailing Address - Street 2:STE 120-338
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7514
Mailing Address - Country:US
Mailing Address - Phone:817-284-9850
Mailing Address - Fax:949-863-6838
Practice Address - Street 1:3600 MAPLESHADE LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5715
Practice Address - Country:US
Practice Address - Phone:972-849-0164
Practice Address - Fax:972-999-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0056WDOtherBCBS
TX8F2271Medicare PIN
TX0056WDOtherBCBS
H71993Medicare UPIN
TX00W832Medicare PIN
TX00W126Medicare PIN
TXDE5685Medicare PIN