Provider Demographics
NPI:1356846307
Name:PERSONAL HEALTH ASSESSMENT
Entity Type:Organization
Organization Name:PERSONAL HEALTH ASSESSMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:KUPPENBENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-410-7422
Mailing Address - Street 1:18320 MICHAEL ANGELO
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287
Mailing Address - Country:US
Mailing Address - Phone:866-410-7422
Mailing Address - Fax:
Practice Address - Street 1:18320 MICHAEL ANGELO DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287
Practice Address - Country:US
Practice Address - Phone:866-410-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty