=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548400872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINES ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2009
-----------------------------------------------------
Last Update Date | 02/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6600 HARWIN DR STE 102
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-2276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-636-7710
-----------------------------------------------------
Fax | 281-861-5990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7234 CANDA LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77083-4831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-636-7710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | CHRISTINE ANN KONOPKO
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 281-636-7710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | MT105529
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------