Healthcare Provider Details

I. General information

NPI: 1770812885
Provider Name (Legal Business Name): BIG COUNTRY REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W MORTON ST STE 114
DENISON TX
75020-1671
US

IV. Provider business mailing address

2300 W MORTON ST STE 114
DENISON TX
75020-1671
US

V. Phone/Fax

Practice location:
  • Phone: 903-462-4085
  • Fax:
Mailing address:
  • Phone: 903-462-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES B SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-462-4085