Provider Demographics
NPI:1144675612
Name:ORTHOPAEDIC AND NEUROLOGICAL REHABILITATION OF TEXAS, INC.
Entity type:Organization
Organization Name:ORTHOPAEDIC AND NEUROLOGICAL REHABILITATION OF TEXAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-275-9419
Mailing Address - Street 1:1101 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:BUILDING G, SUITE 200
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6445
Mailing Address - Country:US
Mailing Address - Phone:512-275-9419
Mailing Address - Fax:
Practice Address - Street 1:1101 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BUILDING G, SUITE 200
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6445
Practice Address - Country:US
Practice Address - Phone:512-275-9419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation