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General NPI Number Information
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NPI Number | 1518370675
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Entity Type | Organization
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Legal Business Name | MEDICO OA REHABILITATION, PLLC
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 3910 FAIRMONT PKWY SUITE G
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City | PASADENA
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State | TX
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Zip | 77504-3076
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Country | US
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Telephone | 281-487-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 3910 FAIRMONT PKWY SUITE G
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City | PASADENA
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State | TX
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Zip | 77504-3076
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Country | US
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Telephone | 281-487-8177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY M MARKS
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Credential | M.D.
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Telephone | 281-487-8177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | J3719
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License Number State | TX
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