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General NPI Number Information
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NPI Number | 1730629403
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Entity Type | Organization
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Legal Business Name | PAIN & REHAB SERVICES OF THE SW
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 4308 GARTH RD STE C
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City | BAYTOWN
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State | TX
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Zip | 77521-3114
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Country | US
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Telephone | 281-837-3757
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Fax | 281-837-7501
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Provider Business Mailing Address
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Address Line | 8251 BEDFORD EULESS RD
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City | N RICHLAND HILLS
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State | TX
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Zip | 76180-7200
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Country | US
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Telephone | 281-837-3757
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Fax | 281-837-7501
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANNON BOYER
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Credential | PHD
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Telephone | 281-837-3757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2-5626
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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