Healthcare Provider Details

I. General information

NPI: 1871607671
Provider Name (Legal Business Name): PRODUCTIVE REHABILITATION INSTITUTE OF DALLAS FOR ERGONOMICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 MAPLE AVE STE 100
DALLAS TX
75235-6596
US

IV. Provider business mailing address

5701 MAPLE AVE STE 100
DALLAS TX
75235-6596
US

V. Phone/Fax

Practice location:
  • Phone: 214-351-6600
  • Fax: 214-351-5046
Mailing address:
  • Phone: 214-351-6600
  • Fax: 214-351-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MRS. HOLLY MAYER
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N., MPH
Phone: 214-351-6600