MEDICARE: HEALIS REHABILITATION CENTER, LLC

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	1217290	TX

General Provider Information

NPI Number	:	1922549120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALIS REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	4309 CARUTH BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6628
Country	:	US
Telephone Number	:	786-251-7786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 CARUTH BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6628
Country	:	US
Telephone Number	:	786-251-7786
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	HEATHER BELL-O'BRIEN
Credential	:	PT
Telephone Number	:	786-251-7786

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	03/20/2017

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