Provider Demographics
NPI:1891064168
Name:NTX PAIN AND REHAB, PLLC
Entity Type:Organization
Organization Name:NTX PAIN AND REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANU
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-577-5437
Mailing Address - Street 1:8000 COIT RD
Mailing Address - Street 2:SUITE 300-342
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6819
Mailing Address - Country:US
Mailing Address - Phone:856-577-5437
Mailing Address - Fax:
Practice Address - Street 1:4549 FIREWHEEL DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3970
Practice Address - Country:US
Practice Address - Phone:856-577-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4446208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty