Provider Demographics
NPI:1316906977
Name:REHABILITATION MEDICAL SPECIALISTS OF DALLAS PA
Entity type:Organization
Organization Name:REHABILITATION MEDICAL SPECIALISTS OF DALLAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-987-1460
Mailing Address - Street 1:PO BOX 678023
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8023
Mailing Address - Country:US
Mailing Address - Phone:214-987-1460
Mailing Address - Fax:214-987-0739
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:STE 508
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-987-1460
Practice Address - Fax:214-987-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080778601Medicaid
TXCG6950OtherMEDICARE RAILROAD
TX080778601Medicaid
TX00557NMedicare PIN