Provider Demographics
NPI:1891138681
Name:DFW PROFESSIONAL DIAGNOSTICS AFFILIATES
Entity Type:Organization
Organization Name:DFW PROFESSIONAL DIAGNOSTICS AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FURNAS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:214-797-7677
Mailing Address - Street 1:4430 LAVON DR
Mailing Address - Street 2:STE 374-113
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3000
Mailing Address - Country:US
Mailing Address - Phone:214-797-7677
Mailing Address - Fax:972-303-9189
Practice Address - Street 1:4430 LAVON DR
Practice Address - Street 2:STE 374-113
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3000
Practice Address - Country:US
Practice Address - Phone:214-797-7677
Practice Address - Fax:972-303-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109947225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty