Provider Demographics
NPI:1700938669
Name:REZA NABAVI, P.T., P.C.
Entity Type:Organization
Organization Name:REZA NABAVI, P.T., P.C.
Other - Org Name:TERRELL PHYSICAL THERAPY AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NABAVI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-270-5555
Mailing Address - Street 1:904 W MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-3004
Mailing Address - Country:US
Mailing Address - Phone:972-563-1824
Mailing Address - Fax:972-524-5929
Practice Address - Street 1:904 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3004
Practice Address - Country:US
Practice Address - Phone:972-563-1824
Practice Address - Fax:972-524-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6056103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00384YMedicare PIN
TX00384YMedicare Oscar/Certification