East Texas Spine Institute, PA
Physical Medicine & Rehabilitation in Tyler, TX. Organization (NPI-2).
NPI number1992985394
StatusActive
Last updated in NPPESJun 11, 2012
Details
- NPI
- 1992985394
- Entity type
- Organization (NPI-2)
- Legal business name
- East Texas Spine Institute, PA
- Organization subpart
- No
- Enumeration date
- Nov 14, 2007
- Last updated
- Jun 11, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | K1283 | TX | Yes |
Practice location
3110 Park Center DrTyler, TX 75701-9215
Phone 903-593-9999 · Fax 903-526-4239
Mailing address
Po Box 130940Tyler, TX 75713-0940
Phone 903-593-9999 · Fax 903-526-4239
Authorized official
Ritesh R Prasad
Owner
9035939999
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