Provider Demographics
NPI:1396988036
Name:REHABILITATION & SPINE ASSOCIATES OF HOUSTON P.A.
Entity type:Organization
Organization Name:REHABILITATION & SPINE ASSOCIATES OF HOUSTON P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-362-0006
Mailing Address - Street 1:111 VISION PARK BLVD
Mailing Address - Street 2:STE # 100
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3002
Mailing Address - Country:US
Mailing Address - Phone:281-362-0006
Mailing Address - Fax:281-362-0233
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:STE # 100
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:281-362-0006
Practice Address - Fax:281-362-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
TX1052512225100000X
TXE6553208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX IDENTIFICATION