Organization
REHAB CENTER, LLC
Active
Other names
Wellness Group
Organization subpart
No
Provider details
NPI number
Authorized official
RANDAL FLOYD OTAIDE (LC MANAGER)
(469) 212-3261
Entity
Organization
Contact information
Practice address
5519 ARAPAHO ROAD, SUITE 108, DALLAS, TX 75248
(469) 212-3261
(214) 484-5990
Mailing address
18208 PRESTON RD, SUITE D9320, DALLAS, TX 75252-6007
(469) 212-3261
(214) 484-5990
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
25360
TX
111NN0400X
Neurology Chiropractor
Primary
5539
TX
225X00000X
Occupational Therapist
104540
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0020JN
BCBS
TX
Enumeration date
04/17/2007
Last updated
09/16/2011
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