Provider Demographics
NPI:1952583254
Name:FAITH PEDIATRIC REHABILITATION
Entity Type:Organization
Organization Name:FAITH PEDIATRIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:STILEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:281-344-1808
Mailing Address - Street 1:1500 JACKSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3250
Mailing Address - Country:US
Mailing Address - Phone:281-344-8108
Mailing Address - Fax:281-344-8107
Practice Address - Street 1:1500 JACKSON ST STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3250
Practice Address - Country:US
Practice Address - Phone:281-344-8108
Practice Address - Fax:281-344-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty