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General NPI Number Information
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NPI Number | 1942558663
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Entity Type | Organization
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Legal Business Name | MAINSTREAM REHABILITATION SERVICES OF TX
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 301 COMMERCE ST
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City | AZLE
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State | TX
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Zip | 76020-2438
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Country | US
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Telephone | 214-727-9546
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Fax |
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Provider Business Mailing Address
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Address Line | 301 COMMERCE
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City | AZLE
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State | TX
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Zip | 76098
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RN/BSN
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Name | TAMMY WILCOX
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Credential |
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Telephone | 214-727-9546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 814047
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License Number State | TX
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