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General NPI Number Information
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NPI Number | 1992902415
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PHYSICAL MEDICINE AND REHABILITATION PA
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 2246 ASH GROVE WAY
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City | DALLAS
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State | TX
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Zip | 75228-5385
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Country | US
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Telephone | 972-201-7988
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Fax | 972-201-7988
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Provider Business Mailing Address
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Address Line | PO BOX 570492
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City | DALLAS
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State | TX
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Zip | 75357-0492
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Country | US
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Telephone | 972-201-7988
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Fax | 972-201-7988
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE AHN
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Credential |
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Telephone | 972-201-7988
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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 | M6489
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License Number State | TX
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