Provider Demographics
NPI:1881812055
Name:ABSOLUTE BODY
Entity type:Organization
Organization Name:ABSOLUTE BODY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:RORICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-496-3355
Mailing Address - Street 1:2550 GRAY FALLS DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6674
Mailing Address - Country:US
Mailing Address - Phone:281-496-3355
Mailing Address - Fax:281-496-4242
Practice Address - Street 1:2550 GRAY FALLS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6674
Practice Address - Country:US
Practice Address - Phone:281-496-3355
Practice Address - Fax:281-496-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4293111N00000X
TXMDE70362081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0272OtherBLUE SHIELD
TX8F0272OtherBLUE CROSS
TX8F0272OtherBLUE SHIELD
TX601787Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER