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General NPI Number Information
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NPI Number | 1073923264
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PHYSIATRY, PLLC
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 5814 SANDSHELL COURT
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City | DALLAS
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State | TX
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Zip | 75252
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Country | US
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Telephone | 972-365-9843
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Fax |
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Provider Business Mailing Address
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Address Line | 5814 SANDSHELL COURT
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City | DALLAS
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State | TX
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Zip | 75252
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DO
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Name | IGOR RAKOVCHIK
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Credential | DO
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Telephone | 972-365-9842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | N4020
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License Number State | TX
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