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General NPI Number Information
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NPI Number | 1265177042
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Entity Type | Organization
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Legal Business Name | SOUTHEAST RESIDENTIAL REHAB LLC
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 2929 ALLEN PKWY STE 200
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City | HOUSTON
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State | TX
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Zip | 77019-7123
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Country | US
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Telephone | 832-341-5395
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Fax | 281-554-6875
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Provider Business Mailing Address
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Address Line | 2929 ALLEN PKWY STE 200
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City | HOUSTON
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State | TX
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Zip | 77019-7123
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Country | US
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Telephone | 832-341-5395
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Fax | 281-554-6875
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Authorized Official
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Title or Position | OWNER
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Name | TITUS JOHN
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Credential | OT
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Telephone | 832-341-5395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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