Provider Demographics
NPI:1326122847
Name:EFTEKHARI, ALIREZA (MS)
Entity Type:Individual
Prefix:MR
First Name:ALIREZA
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550372
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75355-0372
Mailing Address - Country:US
Mailing Address - Phone:214-348-0141
Mailing Address - Fax:
Practice Address - Street 1:2540 N GALLOWAY AVE
Practice Address - Street 2:SUITE 301-A
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4814
Practice Address - Country:US
Practice Address - Phone:972-613-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105811225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B4952Medicare ID - Type Unspecified