Provider Demographics
NPI:1417438458
Name:PROHEALTH REHAB & WELLNESS LLC
Entity type:Organization
Organization Name:PROHEALTH REHAB & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:RESASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-646-6004
Mailing Address - Street 1:715FM 1959RD
Mailing Address - Street 2:1009
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034
Mailing Address - Country:US
Mailing Address - Phone:480-646-6004
Mailing Address - Fax:
Practice Address - Street 1:4112 LEGACY DR STE 326
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0811
Practice Address - Country:US
Practice Address - Phone:480-646-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111NR0400X
251E00000X, 261QM1300X, 261QP2000X, 261QR0400X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty