Provider Demographics
NPI:1285063990
Name:PARA PEDIATRIC & ADULT REHABILITATION ASSOCIATES, PLLC
Entity type:Organization
Organization Name:PARA PEDIATRIC & ADULT REHABILITATION ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-535-9695
Mailing Address - Street 1:PO BOX 23098
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79923-0098
Mailing Address - Country:US
Mailing Address - Phone:806-535-9695
Mailing Address - Fax:
Practice Address - Street 1:3800 N MESA ST STE A2-343
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1538
Practice Address - Country:US
Practice Address - Phone:806-535-9695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-03
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9562208100000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty