Healthcare Provider Details

I. General information

NPI: 1801259585
Provider Name (Legal Business Name): MARK REID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 STELLA LINK RD
HOUSTON TX
77005-4342
US

IV. Provider business mailing address

6725 STELLA LINK RD
HOUSTON TX
77005-4342
US

V. Phone/Fax

Practice location:
  • Phone: 713-669-0500
  • Fax: 713-666-3233
Mailing address:
  • Phone: 713-669-0500
  • Fax: 713-666-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number52198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: