Healthcare Provider Details

I. General information

NPI: 1114267580
Provider Name (Legal Business Name): WELLNESS & INJURY REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 N DURHAM DR
HOUSTON TX
77008
US

IV. Provider business mailing address

1511 N DURHAM DR
HOUSTON TX
77008-3737
US

V. Phone/Fax

Practice location:
  • Phone: 713-862-0035
  • Fax:
Mailing address:
  • Phone: 713-862-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number9174
License Number StateTX

VIII. Authorized Official

Name: DR. JENNY LE
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 713-862-0035