Provider Demographics
NPI:1083480529
Name:BRAIN AND BODY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BRAIN AND BODY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALLAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-436-8480
Mailing Address - Street 1:1500 JULIANAS WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7182
Mailing Address - Country:US
Mailing Address - Phone:646-436-8480
Mailing Address - Fax:
Practice Address - Street 1:1101 ARROW POINT DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7737
Practice Address - Country:US
Practice Address - Phone:646-436-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty