| Organization Name: | SLB LEWISVILLE CLINIC I, LLC |
| NPI Number: | 1083878953 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANDA BICKELHAUPT (OWNER) |
| Mailing Address: | 401 N Valley Pkwy Suite 380 Lewisville |
| State: | TX US |
| Postal Code: | 750673472 |
| Phone Number: | 9723535437 |
| Fax Number: | 9723535436 |
| NPI Enumeration Date: | 07/10/2008 |
| NPI Last Update Date: | 05/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0401X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Taxonomy Definition: | |