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NPI Code Detail

MEDICARE: HOUSTON REHABILITATION SPECIALIST, P.A.

MEDICARE: HOUSTON REHABILITATION SPECIALIST, P.A.
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
1174400000XSpecialistM6929TX

General Provider Information

NPI Number : 1558554402
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOUSTON REHABILITATION SPECIALIST, P.A.
Provider Business Mailing Address
First Line : PO BOX 520
Second Line :
City : KATY
State : TX
Zip : 77492-0520
Country : US
Telephone Number : 281-505-3526
Fax Number : 281-505-3895
Provider Business Practice Location Address
First Line : 23331 GRAND RESERVE DR
Second Line :
City : KATY
State : TX
Zip : 77494-4850
Country : US
Telephone Number : 281-505-3500
Fax Number : 281-505-3895
Authorized Official
Title or Position : OWNER/OPERATOR
Name : DR. DANIQUE LYSANNE VANDONGEN
Credential : MD
Telephone Number : 281-505-3526
Provider Enumeration Date : 08/23/2007
Last Update Date : 06/09/2023

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