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Organization

NEUROMUSCULOSKELETAL REHABILITATION MEDICINE CONSULTANT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA M LEE (VP OPERATIONS)
(817) 284-9850
Entity
Organization

Contact information

Practice address
3600 MAPLESHADE LN, PLANO, TX 75075-5715
(972) 849-0164
(972) 999-4634
Mailing address
7750 N MACARTHUR BLVD, STE 120-338, IRVING, TX 75063-7514
(817) 284-9850
(949) 863-6838

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0056WD
BCBS
TX
Enumeration date
04/06/2006
Last updated
11/25/2024
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