Provider Demographics
NPI:1841472115
Name:GREATER HEALTH AND REHABILITATION, LLC
Entity type:Organization
Organization Name:GREATER HEALTH AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-641-9700
Mailing Address - Street 1:306 GRANBURY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4853
Mailing Address - Country:US
Mailing Address - Phone:817-641-9700
Mailing Address - Fax:817-641-8190
Practice Address - Street 1:306 GRANBURY ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4853
Practice Address - Country:US
Practice Address - Phone:817-641-9700
Practice Address - Fax:817-641-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9660111N00000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13QQOtherBCBS
TXDN8302OtherRR MEDICARE
TX00Z154Medicare PIN
TXU97868Medicare UPIN