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General NPI Number Information
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NPI Number | 1881604429
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Entity Type | Organization
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Legal Business Name | TOTAL RECOVERY PHYSICAL MODALITY
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1100 N UNIVERSITY #240
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City | LITTLE ROCK
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State | AR
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Zip | 72207
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Country | US
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Telephone | 501-614-9774
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Fax | 501-614-0789
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Provider Business Mailing Address
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Address Line | PO BOX 271297
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City | DALLAS
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State | TX
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Zip | 75227
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Country | US
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Telephone | 214-325-9508
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Fax | 214-325-9508
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Authorized Official
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Title or Position | MANAGER SUPERVISOR
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Name | MS. HAZEL R ROBERTS
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Credential |
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Telephone | 214-275-5620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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