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General NPI Number Information
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NPI Number | 1558560144
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL REHABILITATION OF TEXAS PA
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 2800 E BROAD ST SUITE #318
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City | MANSFIELD
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State | TX
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Zip | 76063-6409
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Country | US
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Telephone | 888-724-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 HARRISON PKWY BUILDING C, SUITE #200
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City | SUNRISE
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State | FL
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Zip | 33323-2853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GILBERT DROZDOW
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Credential | MD
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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