MEDICARE: TRITRAX REHABILITATION OF DALLAS, LLC

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1780911297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRITRAX REHABILITATION OF DALLAS, LLC

Provider Business Mailing Address
First Line	:	13619 INWOOD RD
Second Line	:	SUITE 325
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13619 INWOOD RD
Second Line	:	SUITE 325
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4643
Country	:	US
Telephone Number	:	817-275-4744
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. DAVID S MITCHELL
Credential	:
Telephone Number	:	214-542-8334

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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