Healthcare Provider Details

I. General information

NPI: 1194957472
Provider Name (Legal Business Name): BHCFR DFW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 AIRPORT FREEWAY
BEDFORD TX
76021
US

IV. Provider business mailing address

PO BOX 924587
HOUSTON TX
77292-4587
US

V. Phone/Fax

Practice location:
  • Phone: 713-586-6705
  • Fax: 713-586-6752
Mailing address:
  • Phone: 713-586-6705
  • Fax: 713-586-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number801031038
License Number StateTX

VIII. Authorized Official

Name: LINDA KELLNER
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 713-586-6705