Provider Demographics
NPI:1083731335
Name:NEUROTHERAPY CENTER OF DALLAS
Entity Type:Organization
Organization Name:NEUROTHERAPY CENTER OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-991-1153
Mailing Address - Street 1:12870 HILLCREST RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1531
Mailing Address - Country:US
Mailing Address - Phone:972-991-1153
Mailing Address - Fax:972-991-1346
Practice Address - Street 1:12870 HILLCREST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1531
Practice Address - Country:US
Practice Address - Phone:972-991-1153
Practice Address - Fax:972-991-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00294UMedicare PIN
TXC23088Medicare UPIN