=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447703582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYLOR INSTITUTE FOR REHABHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2016
-----------------------------------------------------
Last Update Date | 07/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1740 N COLLINS BLVD SUITE 100
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-235-9035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1740 N COLLINS BLVD STE 100
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. COREY VOGES
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 972-235-9035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 1272051
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------