Provider Demographics
NPI:1194164178
Name:MEDICAL REHABILITATION CLINIC OF MESQUITE, INC
Entity type:Organization
Organization Name:MEDICAL REHABILITATION CLINIC OF MESQUITE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:EMEKA
Authorized Official - Last Name:OKECHUKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-279-7377
Mailing Address - Street 1:9205 SKILLMAN ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9031
Mailing Address - Country:US
Mailing Address - Phone:972-279-7377
Mailing Address - Fax:214-349-7200
Practice Address - Street 1:9205 SKILLMAN ST
Practice Address - Street 2:SUITE 117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9031
Practice Address - Country:US
Practice Address - Phone:972-279-7377
Practice Address - Fax:214-349-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L0888207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty