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General NPI Number Information
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NPI Number | 1235406729
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Entity Type | Organization
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Legal Business Name | BODIES IN BALANCE MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 4151 SW FWY STE 210
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City | HOUSTON
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State | TX
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Zip | 77027-7312
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Country | US
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Telephone | 713-395-6308
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Fax | 713-758-0153
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Provider Business Mailing Address
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Address Line | PO BOX 25401
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City | HOUSTON
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State | TX
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Zip | 77265-5401
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Country | US
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Telephone | 713-395-6308
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Fax | 713-758-0153
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Authorized Official
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Title or Position | OWNER
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Name | EMILIO R CARDONA
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Credential | MD
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Telephone | 713-395-6308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E5353
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | E5353
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State | TX
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