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General NPI Number Information
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NPI Number | 1548409634
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Entity Type | Organization
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Legal Business Name | TERRELL MEDICAL CLINIC & REHAB PA
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 1553 HIGHWAY 34 S SUITE 300
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City | TERRELL
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State | TX
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Zip | 75160-4833
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Country | US
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Telephone | 972-563-1636
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Fax | 972-551-6968
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Provider Business Mailing Address
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Address Line | 1553 HIGHWAY 34 S SUITE 300
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City | TERRELL
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State | TX
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Zip | 75160-4833
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Country | US
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Telephone | 972-563-1636
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Fax | 972-551-6968
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Authorized Official
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Title or Position | CEO
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Name | DR. MARLON D PADILLA
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Credential | MD
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Telephone | 972-563-1636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 558614
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | K2254
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License Number State | TX
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