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General NPI Number Information
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NPI Number | 1629013230
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Entity Type | Organization
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Legal Business Name | MNM LONESTAR REHABILITATION, INC.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 915 AVENUE C
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City | DENTON
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State | TX
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Zip | 76201-6545
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Country | US
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Telephone | 940-595-0566
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 634
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City | JUSTIN
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State | TX
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Zip | 76247-0634
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Country | US
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Telephone | 940-595-0566
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW NIEMIERA
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Credential | PT, CERT. MDT
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Telephone | 940-595-0566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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