Healthcare Provider Details

I. General information

NPI: 1396918538
Provider Name (Legal Business Name): SPINE TEAM TEXAS-ROCKWALL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 HORIZON ROAD SUITE 100
ROCKWALL TX
75032
US

IV. Provider business mailing address

1545 E SOUTHLAKE BLVD SUITE 100
SOUTHLAKE TX
76092-6422
US

V. Phone/Fax

Practice location:
  • Phone: 972-772-9600
  • Fax: 972-772-9601
Mailing address:
  • Phone: 817-442-9300
  • Fax: 817-796-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK HOOD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 972-772-9600