Provider Demographics
NPI:1912943879
Name:MOSALLAIE REHAB ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:MOSALLAIE REHAB ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEIKHOSROW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSALLAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHD
Authorized Official - Phone:214-727-1180
Mailing Address - Street 1:5225 MAPLE AVE
Mailing Address - Street 2:3101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8195
Mailing Address - Country:US
Mailing Address - Phone:214-727-1180
Mailing Address - Fax:
Practice Address - Street 1:5225 MAPLE AVE
Practice Address - Street 2:3101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-8195
Practice Address - Country:US
Practice Address - Phone:214-727-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9821208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty