Healthcare Provider Details

I. General information

NPI: 1396988036
Provider Name (Legal Business Name): REHABILITATION & SPINE ASSOCIATES OF HOUSTON P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VISION PARK BLVD STE # 100
SHENANDOAH TX
77384-3002
US

IV. Provider business mailing address

111 VISION PARK BLVD STE # 100
SHENANDOAH TX
77384-3002
US

V. Phone/Fax

Practice location:
  • Phone: 281-362-0006
  • Fax: 281-362-0233
Mailing address:
  • Phone: 281-362-0006
  • Fax: 281-362-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1052512
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberE6553
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT A MOORE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 281-362-0006