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General NPI Number Information
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NPI Number | 1831359611
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Entity Type | Organization
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Legal Business Name | PHENOMENAL REHAB, LLC
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Dates
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Enumeration Date | 06/14/2008
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 807 S FRIENDSWOOD DR SUITE #1
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-4583
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Country | US
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Telephone | 832-221-8199
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Fax | 281-992-4397
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Provider Business Mailing Address
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Address Line | 807 S FRIENDSWOOD DR SUITE #1
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-4583
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Country | US
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Telephone | 832-221-8199
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Fax | 281-992-4397
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JAMILLA M DOWE
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Credential | PT, DPT, MBA
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Telephone | 832-221-8199
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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 | 1141141
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License Number State | TX
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