MEDICARE: ADVANCED MEDICINE & REHABILITATION OF TEXAS

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	207R00000X	Internal Medicine Physician	H8719	TX
2	208VP0000X	Pain Medicine Physician	D1711	TX
3	225X00000X	Occupational Therapist	100390	TX
4	207X00000X	Orthopaedic Surgery Physician	G4220	TX

General Provider Information

NPI Number	:	1154593283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICINE & REHABILITATION OF TEXAS

Provider Business Mailing Address
First Line	:	PO BOX 31223
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-0021
Country	:	US
Telephone Number	:	214-696-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 ABRAMS RD # 112
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2000
Country	:	US
Telephone Number	:	214-696-2273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FARIDEH HEIDARPOUR
Credential	:
Telephone Number	:	214-696-2273

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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1255576369 — ADVANCED MEDICINE AND REHABILITATION OF TEXAS, INC.
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Directions to “ADVANCED MEDICINE & REHABILITATION OF TEXAS ” Practice Location

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