MEDICARE: NISAL CORP.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	111N00000X	Chiropractor
3	2083X0100X	Occupational Medicine Physician
4	225100000X	Physical Therapist
5	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1275826604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NISAL CORP.

Provider Business Mailing Address
First Line	:	PO BOX 24809
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77229-4809
Country	:	US
Telephone Number	:	713-652-3145
Fax Number	:	713-652-3146

Provider Business Practice Location Address
First Line	:	2918 SAN JACINTO ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-2708
Country	:	US
Telephone Number	:	713-652-3145
Fax Number	:	713-652-3146

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MS. CARMEN L MANZO
Credential	:
Telephone Number	:	713-378-0667

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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Directions to “NISAL CORP. ” Practice Location

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