Provider Demographics
NPI:1730269085
Name:GARDEN, FAE (MD)
Entity type:Individual
Prefix:DR
First Name:FAE
Middle Name:
Last Name:GARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:REHABILITATION CARE LINE 117
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:REHABILITATION CARE LANE 117
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-7168
Practice Address - Fax:713-794-7631
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3385208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134878105Medicaid
TX134878105Medicaid
E77919Medicare UPIN
TXTXB113874Medicare PIN
TXP00010425Medicare PIN
TX85X612Medicare PIN