Provider Demographics
NPI:1508036963
Name:EXPRESSIONS PAIN AND REHAB, P.A.
Entity Type:Organization
Organization Name:EXPRESSIONS PAIN AND REHAB, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-291-9165
Mailing Address - Street 1:PO BOX 222093
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-2093
Mailing Address - Country:US
Mailing Address - Phone:972-291-9165
Mailing Address - Fax:
Practice Address - Street 1:510 W FM 1382
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5322
Practice Address - Country:US
Practice Address - Phone:972-291-9165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9668208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty