Southern Neuro Rehab Institiute, PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

J0839 Issued in TX

Legal business name

SOUTHERN NEURO REHAB INSTITIUTE, PLLC

Doing business as

Southern Neuro Rehab Institiute

Practice address

3430 W Wheatland Rd
Suite 107
Dallas, TX 75237-3446

Phone

(972) 572-4000

Fax

(972) 572-3992

NPI assigned

Jul 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chiufang Hwang, M.D.

Title

Administrator

Phone

(972) 572-4000

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Southern Neuro Rehab Institiute Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peggy Lorene Wentrcek, NP

  • Nurse Practitioner
  • Plano, TX
  • NPI 1144318585
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1760411847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3430 W WHEATLAND RD",
            "address_2": "SUITE 107",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752373446",
            "telephone_number": "972-572-4000",
            "fax_number": "972-572-3992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3430 W WHEATLAND RD",
            "address_2": "SUITE 107",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752373446",
            "telephone_number": "972-572-4000",
            "fax_number": "972-572-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN NEURO REHAB INSTITIUTE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "HWANG",
        "authorized_official_first_name": "CHIUFANG",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-572-4000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "J0839",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "J0839",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162297901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TX",
            "identifier": "0082KP",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Neuro Rehab Institiute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Medicine & Rehabilitation Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Physical Medicine & Rehabilitation Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.