Provider Demographics
NPI:1194913525
Name:BRIDGE CITY OCCUPATIONAL REHABILITATION AND PAIN MANAGEMENT, INC.
Entity type:Organization
Organization Name:BRIDGE CITY OCCUPATIONAL REHABILITATION AND PAIN MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:409-697-3718
Mailing Address - Street 1:1010 W ROUND BUNCH RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2344
Mailing Address - Country:US
Mailing Address - Phone:409-697-3718
Mailing Address - Fax:409-697-3963
Practice Address - Street 1:1010 W ROUND BUNCH RD
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-2344
Practice Address - Country:US
Practice Address - Phone:409-697-3718
Practice Address - Fax:409-697-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11334522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty