Healthcare Provider Details

I. General information

NPI: 1003351768
Provider Name (Legal Business Name): UTCH PAIN & REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CULLEN BLVD SUITE 202
PEARLAND TX
77581-8961
US

IV. Provider business mailing address

8900 SHOAL CREEK BLVD SUITE 200
AUSTIN TX
78757-6810
US

V. Phone/Fax

Practice location:
  • Phone: 281-412-0900
  • Fax: 281-412-4020
Mailing address:
  • Phone: 512-323-6900
  • Fax: 512-375-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP1202492
License Number StateTX

VIII. Authorized Official

Name: MRS. PAMELA B DAVIS
Title or Position: CONTRACT COORDINATOR
Credential:
Phone: 512-323-6900