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NPI Code Detail

MEDICARE: INCLUSIVE WELLNESS & REHABILITATION PLLC

MEDICARE: INCLUSIVE WELLNESS & REHABILITATION 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
1207Q00000XFamily Medicine PhysicianL6405TX
2207R00000XInternal Medicine PhysicianL6405TX
32081P2900XPain Medicine (Physical Medicine & Rehabilitation) PhysicianL6405TX
4208D00000XGeneral Practice PhysicianL6405TX
5261QM1300XMulti-Specialty Clinic/Center801599338TX

General Provider Information

NPI Number : 1891055026
Entity Type Code : Organization
Provider Name (Legal Business Name) : INCLUSIVE WELLNESS & REHABILITATION PLLC
Provider Business Mailing Address
First Line : 5644 WESTHEIMER RD # 347
Second Line :
City : HOUSTON
State : TX
Zip : 77056-4002
Country : US
Telephone Number : 832-407-2276
Fax Number :
Provider Business Practice Location Address
First Line : 6550 MAPLERIDGE ST STE 115
Second Line :
City : HOUSTON
State : TX
Zip : 77081-4629
Country : US
Telephone Number : 713-370-2274
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : RONALD A GREEN
Credential : MD
Telephone Number : 713-370-2274
Provider Enumeration Date : 05/22/2012
Last Update Date : 05/22/2012

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