Healthcare Provider Details

I. General information

NPI: 1629013230
Provider Name (Legal Business Name): MNM LONESTAR REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 AVENUE C
DENTON TX
76201-6545
US

IV. Provider business mailing address

PO BOX 634
JUSTIN TX
76247-0634
US

V. Phone/Fax

Practice location:
  • Phone: 940-595-0566
  • Fax:
Mailing address:
  • Phone: 940-595-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW NIEMIERA
Title or Position: PRESIDENT
Credential: PT, CERT. MDT
Phone: 940-595-0566