Healthcare Provider Details

I. General information

NPI: 1265582910
Provider Name (Legal Business Name): ROCKWALL CARDIO PULMONARY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 RIDGE RD SUITE 205
ROCKWALL TX
75087-2569
US

IV. Provider business mailing address

2504 RIDGE RD SUITE 205
ROCKWALL TX
75087-2569
US

V. Phone/Fax

Practice location:
  • Phone: 972-768-9230
  • Fax: 972-722-4087
Mailing address:
  • Phone: 972-768-9230
  • Fax: 972-722-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateTX

VIII. Authorized Official

Name: LORI SUZZETTE AARON
Title or Position: OWNER
Credential: R.T.
Phone: 903-227-1088