MEDICARE: ANVIK REHAB CENTER, ONC.

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	225100000X	Physical Therapist
2	2251X0800X	Orthopedic Physical Therapist
3	2255A2300X	Athletic Trainer
4	225700000X	Massage Therapist
5	225C00000X	Rehabilitation Counselor
6	225XP0019X	Physical Rehabilitation Occupational Therapist
7	226300000X	Kinesiotherapist
8	283X00000X	Rehabilitation Hospital
9	111N00000X	Chiropractor	9753	TX

General Provider Information

NPI Number	:	1548414170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANVIK REHAB CENTER, ONC.

Provider Business Mailing Address
First Line	:	4152 W SPRING CREEK PKWY STE 116
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5315
Country	:	US
Telephone Number	:	972-612-5363
Fax Number	:	972-612-5782

Provider Business Practice Location Address
First Line	:	4152 W SPRING CREEK PKWY STE 116
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5315
Country	:	US
Telephone Number	:	972-612-5363
Fax Number	:	972-612-5782

Authorized Official
Title or Position	:	OWNER
Name	:	ANATOLY V KOLMAKOV
Credential	:	LMT
Telephone Number	:	972-612-5363

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	04/30/2009

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