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General NPI Number Information
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NPI Number | 1245455963
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Entity Type | Organization
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Legal Business Name | NORTH EAST REHAB CENTER WILLOWBROOK
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 13300 HARGRAVE RD SUITE 490
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City | HOUSTON
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State | TX
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Zip | 77070-4373
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Country | US
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Telephone | 281-646-1935
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Fax | 281-646-0927
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Provider Business Mailing Address
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Address Line | 13300 HARGRAVE RD SUITE 490
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City | HOUSTON
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State | TX
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Zip | 77070-4373
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Country | US
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Telephone | 281-646-1935
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Fax | 281-646-0927
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | MRS. SANDRA ANN SHIRAH
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Credential | ADMINISTRATOR
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Telephone | 281-646-1935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1081537
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License Number State | TX
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