=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568708089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH RESTORATION PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2013
-----------------------------------------------------
Last Update Date | 04/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11511 KATY FWY STE 510
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-595-9595
-----------------------------------------------------
Fax | 832-598-2429
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1825 UPLAND DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77043-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-595-9595
-----------------------------------------------------
Fax | 832-598-2429
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TIMOTHY G DIXON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-298-0028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------