Healthcare Provider Details

I. General information

NPI: 1932441383
Provider Name (Legal Business Name): HEALTHCARE REHAB GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S WESTMORELAND RD
DALLAS TX
75237-1622
US

IV. Provider business mailing address

PO BOX 224585
DALLAS TX
75222-4585
US

V. Phone/Fax

Practice location:
  • Phone: 214-339-2047
  • Fax: 214-339-2049
Mailing address:
  • Phone: 214-339-2047
  • Fax: 214-339-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10714
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10714
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number23078
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number23078
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number23078
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number23078
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9202
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number9202
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number9202
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP2873
License Number StateTX
# 11
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberP2873
License Number StateTX
# 12
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberP2873
License Number StateTX
# 13
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberP2873
License Number StateTX
# 14
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberP2873
License Number StateTX

VIII. Authorized Official

Name: STAR SCOTT
Title or Position: OFFICE MANAGER
Credential:
Phone: 214-339-2047