MEDICARE: PARAMOUNT PRINCE REHABILITATION, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1023596590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT PRINCE REHABILITATION, LP

Provider Business Mailing Address
First Line	:	105 N TRENTON ST
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-4321
Country	:	US
Telephone Number	:	318-255-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	11855 LEBANON RD
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-8225
Country	:	US
Telephone Number	:	469-269-1000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER BURTON
Credential	:	MS, MBA
Telephone Number	:	214-325-1462

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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