Provider Demographics
NPI:1740509868
Name:TMO MEDICAL AND REHAB
Entity type:Organization
Organization Name:TMO MEDICAL AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TEKLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-702-0195
Mailing Address - Street 1:2626 S LOOP W
Mailing Address - Street 2:STE 435
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2654
Mailing Address - Country:US
Mailing Address - Phone:713-669-1400
Mailing Address - Fax:713-669-1421
Practice Address - Street 1:2626 S LOOP W
Practice Address - Street 2:STE 435
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2654
Practice Address - Country:US
Practice Address - Phone:713-669-1400
Practice Address - Fax:713-669-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty