Organization
NEURO REHAB ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA DAVIDOVICH (DIRECTOR)
(817) 421-9111
Entity
Organization
Contact information
Practice address
680 N CARROLL AVE, SUITE 120, SOUTHLAKE, TX 76092-6467
(817) 421-9111
(817) 421-9222
Mailing address
PO BOX 92248, SOUTHLAKE, TX 76092-0103
(817) 421-9111
(817) 421-9222
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
E5103
TX
Other
Enumeration date
09/18/2007
Last updated
09/18/2007
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