MEDICARE: TRINITY PHYSICAL MEDICINE AND REHAB, 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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1720510795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY PHYSICAL MEDICINE AND REHAB, PLLC

Provider Business Mailing Address
First Line	:	7062 HIGHLANDS LN
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0590
Country	:	US
Telephone Number	:	903-483-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	7062 HIGHLANDS LN
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0590
Country	:	US
Telephone Number	:	903-483-1090
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. MICHELLE DUNN
Credential	:
Telephone Number	:	903-483-1090

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/29/2017

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