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General NPI Number Information
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NPI Number | 1457742744
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Entity Type | Organization
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Legal Business Name | DESOTO INJURY REHAB LLC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 509 N HAMPTON RD STE 100A
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City | DESOTO
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State | TX
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Zip | 75115-4970
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Country | US
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Telephone | 469-297-6575
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Fax | 469-533-0307
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Provider Business Mailing Address
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Address Line | 509 N HAMPTON RD STE 100A
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City | DESOTO
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State | TX
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Zip | 75115-4970
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Country | US
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Telephone | 469-297-6575
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Fax | 469-533-0307
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Authorized Official
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Title or Position | PARTNER
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Name | MR. DAVID LONG
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Credential |
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Telephone | 469-297-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | F0011366
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License Number State | TX
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