MEDICARE: AGILITY REHABILITATION AND INJURY CENTER

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	111N00000X	Chiropractor	11658	TX

General Provider Information

NPI Number	:	1285035915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGILITY REHABILITATION AND INJURY CENTER

Provider Business Mailing Address
First Line	:	3402 OLD SPANISH TRL
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77021-2265
Country	:	US
Telephone Number	:	281-974-3544
Fax Number	:	281-974-3587

Provider Business Practice Location Address
First Line	:	3402 OLD SPANISH TRL
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77021-2265
Country	:	US
Telephone Number	:	281-974-3544
Fax Number	:	281-974-3587

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. BENJAMIN MAURICE MESHACK
Credential	:	D.C.
Telephone Number	:	281-974-3544

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	09/12/2014

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