NPI age
19 years
Enumerated 2007-03-08
Across 1738 active physical medicine & rehabilitation providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (MO) | 2005032249 | MISSOURI TEMP LICENSE |
| 01 (TX) | 518857YPVD | TX MEDICARE-PREMIER |
| 01 (KS) | 6310 | KANSAS TEMPORARY LICENSE |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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