Provider Demographics
NPI:1740343631
Name:FOREST HILL DIAGNOSTIC & REHABILITATION, INC.
Entity type:Organization
Organization Name:FOREST HILL DIAGNOSTIC & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUDIB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-568-9200
Mailing Address - Street 1:3304 SE LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1108
Mailing Address - Country:US
Mailing Address - Phone:817-568-9200
Mailing Address - Fax:
Practice Address - Street 1:3304 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-1108
Practice Address - Country:US
Practice Address - Phone:817-568-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180052700OtherUS DEPT. OF LABOR