Healthcare Provider Details

I. General information

NPI: 1336324953
Provider Name (Legal Business Name): BBC REHAB & DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N BUCKNER BLVD SUITE 305
DALLAS TX
75218-3426
US

IV. Provider business mailing address

1151 N BUCKNER BLVD SUITE 305
DALLAS TX
75218-3426
US

V. Phone/Fax

Practice location:
  • Phone: 972-270-4800
  • Fax: 214-367-1153
Mailing address:
  • Phone: 972-270-4800
  • Fax: 214-367-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: DANA DIANE LACKEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 972-270-4800