MEDICARE: KMA REHABILITATION AND WELLNESS CENTER, INC.

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
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1982100129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMA REHABILITATION AND WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	15821 FM 529 RD STE 327
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2503
Country	:	US
Telephone Number	:	281-861-0919
Fax Number	:

Provider Business Practice Location Address
First Line	:	16103 W LITTLE YORK RD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-6867
Country	:	US
Telephone Number	:	832-964-7261
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BIANCA ADAMS
Credential	:
Telephone Number	:	281-861-0919

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	12/16/2019

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