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General NPI Number Information
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NPI Number | 1003286329
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Entity Type | Organization
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Legal Business Name | ADVANCED FUNCTIONAL REHAB
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 5959 WEST LOOP S SUITE 250
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City | BELLAIRE
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State | TX
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Zip | 77401-2421
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Country | US
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Telephone | 281-410-8750
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Fax | 281-709-6797
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Provider Business Mailing Address
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Address Line | 17424 W GRAND PKWY S SUITE 521
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City | SUGAR LAND
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State | TX
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Zip | 77479-2564
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Country | US
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Telephone | 281-410-8750
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Fax | 281-709-6797
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Authorized Official
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Title or Position | PARTNER
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Name | DR. PLESHETTE B JOHNSON-WIGGINS
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Credential | D.C.
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Telephone | 281-410-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number | 9316
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License Number State | TX
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