Healthcare Provider Details

I. General information

NPI: 1669810917
Provider Name (Legal Business Name): MEDICAL OPTIMAL RECOVERY SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 BEE CAVES ROAD SUITE K-200
AUSTIN TX
78746
US

IV. Provider business mailing address

PO BOX 915
WALLER TX
77484-0915
US

V. Phone/Fax

Practice location:
  • Phone: 512-773-6145
  • Fax:
Mailing address:
  • Phone: 512-773-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELODY MASTERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-773-6145