Provider Demographics
NPI:1366729352
Name:NORTH TEXAS REHAB PLLC
Entity type:Organization
Organization Name:NORTH TEXAS REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-470-5019
Mailing Address - Street 1:PO BOX 941042
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-1042
Mailing Address - Country:US
Mailing Address - Phone:972-783-8000
Mailing Address - Fax:972-783-4267
Practice Address - Street 1:1111 W SHORE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4046
Practice Address - Country:US
Practice Address - Phone:972-783-8000
Practice Address - Fax:972-783-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0457208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB141724Medicare PIN