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General NPI Number Information
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NPI Number | 1154512168
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL RESTORATION SERVICES OF TEXAS, LLC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 11275 S SAM HOUSTON PKWY W SUITE 150
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City | HOUSTON
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State | TX
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Zip | 77031-2357
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Country | US
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Telephone | 832-328-4545
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Fax | 832-328-4548
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Provider Business Mailing Address
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Address Line | 11275 S SAM HOUSTON PKWY W SUITE 150
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City | HOUSTON
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State | TX
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Zip | 77031-2357
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Country | US
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Telephone | 832-328-4545
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Fax | 832-328-4548
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Authorized Official
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Title or Position | PROGRAM DIRECTOR/OWNER
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Name | DR. DANIEL VICTOR BODIN
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Credential |
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Telephone | 713-962-4377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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