Provider Demographics
NPI:1265582910
Name:ROCKWALL CARDIO PULMONARY CLINIC LLC
Entity type:Organization
Organization Name:ROCKWALL CARDIO PULMONARY CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SUZZETTE
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:903-227-1088
Mailing Address - Street 1:2504 RIDGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2569
Mailing Address - Country:US
Mailing Address - Phone:972-768-9230
Mailing Address - Fax:972-722-4087
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:972-768-9230
Practice Address - Fax:972-722-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)