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General NPI Number Information
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NPI Number | 1386878783
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Entity Type | Organization
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Legal Business Name | LIFESTYLE HEARING CLINIC
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 701 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-2355
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Country | US
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Telephone | 817-776-7915
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Fax |
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Provider Business Mailing Address
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Address Line | 701 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-2355
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Country | US
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Telephone | 817-776-7915
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT A ROGERS
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Credential | BCHIS
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Telephone | 817-776-7915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 80222
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License Number State | TX
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