=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851569263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAFFORD REHABILITATION SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2008
-----------------------------------------------------
Last Update Date | 02/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7457 HARWIN DR SUITE 134
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-334-3327
-----------------------------------------------------
Fax | 713-334-3319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7457 HARWIN DR SUITE 134
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-334-3327
-----------------------------------------------------
Fax | 713-334-3319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | RICHARD JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-334-3327
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | F004913
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------