Provider Demographics
NPI:1457958225
Name:MAJESTIC REHABILITATION AND WELLNESS INC
Entity Type:Organization
Organization Name:MAJESTIC REHABILITATION AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PIUS
Authorized Official - Middle Name:O
Authorized Official - Last Name:SODIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-626-6120
Mailing Address - Street 1:11199 PELLICANO DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-5304
Mailing Address - Country:US
Mailing Address - Phone:915-626-6120
Mailing Address - Fax:915-856-3668
Practice Address - Street 1:11199 PELLICANO DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-5304
Practice Address - Country:US
Practice Address - Phone:915-626-6120
Practice Address - Fax:915-856-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32075565690OtherSTATE
TX32075565690OtherSTATE IDENTIFICATION NUMBER