MEDICARE: SPINAL REHAB PA

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	111NS0005X	Sports Physician Chiropractor	7033	TX

General Provider Information

NPI Number	:	1225283823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL REHAB PA

Provider Business Mailing Address
First Line	:	1120 S CAPITAL OF TEXAS HWY STE 250
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6464
Country	:	US
Telephone Number	:	512-258-4425
Fax Number	:	512-258-4553

Provider Business Practice Location Address
First Line	:	1120 S CAPITAL OF TEXAS HWY STE 250
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6464
Country	:	US
Telephone Number	:	512-258-4425
Fax Number	:	512-258-4553

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT RONALD MEYER
Credential	:	D.C.
Telephone Number	:	512-258-4425

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	03/08/2019

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