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General NPI Number Information
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NPI Number | 1174992663
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Entity Type | Organization
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Legal Business Name | BACK & BODY RECOVERY
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 3933 BROADWAY ST SUITE 300
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City | HOUSTON
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State | TX
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Zip | 77087-4758
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Country | US
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Telephone | 281-578-5115
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Fax | 281-929-0784
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Provider Business Mailing Address
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Address Line | PO BOX 11145
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City | SPRING
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State | TX
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Zip | 77391-1145
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Country | US
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Telephone | 281-578-5115
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Fax | 281-929-0784
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAN NGUYEN
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Credential | D.C
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Telephone | 281-578-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 9635
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License Number State | TX
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