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General NPI Number Information
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NPI Number | 1265598734
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Entity Type | Organization
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Legal Business Name | ADOM REHAB AND PHYSICAL MEDICINE
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 10600 FONDREN RD #101
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City | HOUSTON
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State | TX
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Zip | 77096
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Country | US
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Telephone | 713-776-0091
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Fax | 713-776-0093
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Provider Business Mailing Address
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Address Line | 10600 FONDREN RD SUITE #101
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City | HOUSTON
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State | TX
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Zip | 77096
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Country | US
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Telephone | 713-776-0252
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Fax | 713-776-0093
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TINA O COLLINS
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Credential | DC
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Telephone | 713-776-0252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC6816
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | F8454
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License Number State | TX
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