Provider Demographics
NPI:1205076494
Name:TEXAS MOBILE FOOT CONSULTANTS, LLC
Entity type:Organization
Organization Name:TEXAS MOBILE FOOT CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY-NIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-526-7567
Mailing Address - Street 1:12705 RIO BRAVO ST
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4073
Mailing Address - Country:US
Mailing Address - Phone:832-526-7567
Mailing Address - Fax:713-948-0401
Practice Address - Street 1:3222 BURKE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1859
Practice Address - Country:US
Practice Address - Phone:713-948-0400
Practice Address - Fax:713-948-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1618213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty