Provider Demographics
NPI:1902553308
Name:REALITY RESUSCITATION LAB
Entity Type:Organization
Organization Name:REALITY RESUSCITATION LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:832-215-8356
Mailing Address - Street 1:7223 SANDSWEPT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-1847
Mailing Address - Country:US
Mailing Address - Phone:832-215-8356
Mailing Address - Fax:
Practice Address - Street 1:7223 SANDSWEPT LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-1847
Practice Address - Country:US
Practice Address - Phone:832-215-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346997756OtherNPI
1326790106OtherNPI