Healthcare Provider Details
I. General information
NPI: 1992951602
Provider Name (Legal Business Name): SUNRISE REHABILITATION AND PAIN MANAGEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
914 W ANDERSON LN
AUSTIN TX
78757-1546
US
IV. Provider business mailing address
914 W ANDERSON LN
AUSTIN TX
78757-1546
US
V. Phone/Fax
- Phone: 512-454-7631
- Fax:
- Phone: 512-454-7631
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QP2000X |
| Taxonomy | Physical Therapy Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
CURTIS
JOHN
HALL
Title or Position: OWNER
Credential: D.C.
Phone: 512-454-7631