Organization
LASER REHABILITATION CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE S EARL LILT AND BCHIS (OWNER OPERATOR)
(409) 882-0696
Entity
Organization
Contact information
Practice address
3212 CONCORD DRIVE, SUITE E, ORANGE, TX 77630
(409) 882-0696
(409) 882-0427
Mailing address
3212 CONCORD DRIVE, SUITE E, ORANGE, TX 77630
(409) 882-0696
(409) 882-0427
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022433901
—
TX
01
—
50306
HEARING AID SPECIALIST
TX
Enumeration date
01/19/2007
Last updated
07/22/2008
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