Provider Demographics
NPI:1922448307
Name:DALLAS NEUROREHAB CENTER, PLLC
Entity Type:Organization
Organization Name:DALLAS NEUROREHAB CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:OSUJI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-226-2680
Mailing Address - Street 1:320 DECKER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3937
Mailing Address - Country:US
Mailing Address - Phone:972-739-6093
Mailing Address - Fax:
Practice Address - Street 1:320 DECKER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3937
Practice Address - Country:US
Practice Address - Phone:972-739-6093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33993103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty