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General NPI Number Information
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NPI Number | 1205831823
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Entity Type | Organization
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Legal Business Name | HEALTHTEXAS PROVIDER NETWORK - PHYSIATRIC MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 507 N HIGHWAY 77 STE 700
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1889
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Country | US
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Telephone | 972-923-2738
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Fax | 972-935-9230
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Provider Business Mailing Address
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Address Line | 8080 N CENTRAL EXPY, LB 82 STE 1650
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City | DALLAS
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State | TX
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Zip | 75206-3789
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Country | US
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Telephone | 972-860-8653
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Fax | 972-860-8679
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ELLEN ELIZABETH FOURTON
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Credential |
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Telephone | 972-860-8649
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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 | 0016AH
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License Number State | TX
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