MEDICARE: BRIDGE CITY OCCUPATIONAL REHABILITATION AND PAIN MANAGEMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	1133452	TX

General Provider Information

NPI Number	:	1194913525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE CITY OCCUPATIONAL REHABILITATION AND PAIN MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	1010 W ROUND BUNCH RD
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611-2344
Country	:	US
Telephone Number	:	409-697-3718
Fax Number	:	409-697-3963

Provider Business Practice Location Address
First Line	:	1010 W ROUND BUNCH RD
Second Line	:
City	:	BRIDGE CITY
State	:	TX
Zip	:	77611-2344
Country	:	US
Telephone Number	:	409-697-3718
Fax Number	:	409-697-3963

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. BRIAN JAMES ROGERS
Credential	:	DPT
Telephone Number	:	409-697-3718

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	04/09/2008

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