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General NPI Number Information
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NPI Number | 1770856338
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Entity Type | Organization
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Legal Business Name | RELAX & REHAB
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 4931 ALLEN-GENOA RD.
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City | PASADENA
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State | TX
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Zip | 77054
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Country | US
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Telephone | 832-368-4010
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 7321
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City | PASADENA
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State | TX
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Zip | 77508-7321
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Country | US
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Telephone | 832-368-4010
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Fax |
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Authorized Official
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Title or Position | REHABILITATION PRACTITIONER/LICENSE
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Name | RANDELL LEE CARSON
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Credential | MASTERS IN HEALTH CA
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Telephone | 832-368-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT032379
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 02242001
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License Number State | TX
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