MEDICARE: PARA PEDIATRIC & ADULT REHABILITATION ASSOCIATES, PLLC

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	N9562	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	N9562	TX

General Provider Information

NPI Number	:	1285063990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARA PEDIATRIC & ADULT REHABILITATION ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 23098
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79923-0098
Country	:	US
Telephone Number	:	806-535-9695
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 N MESA ST STE A2-343
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:	806-535-9695
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CALLENDA HACKER
Credential	:	M.D.
Telephone Number	:	806-535-9695

Provider Enumeration Date	:	11/03/2013
Last Update Date	:	03/19/2014

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