Organization
SOUTHERN NEURO REHAB INSTITIUTE, PLLC
Active
Other names
Southern Neuro Rehab Institiute
Organization subpart
No
Provider details
NPI number
Authorized official
CHIUFANG HWANG M.D. (ADMINISTRATOR)
(972) 572-4000
Entity
Organization
Contact information
Practice address
3430 W WHEATLAND RD, SUITE 107, DALLAS, TX 75237-3446
(972) 572-4000
(972) 572-3992
Mailing address
3430 W WHEATLAND RD, SUITE 107, DALLAS, TX 75237-3446
(972) 572-4000
(972) 572-3992
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J0839
TX
2084N0400X
Neurology Physician
J0839
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0082KP
BLUE CROSS BLUE SHIELD TX
TX
05
—
162297901
—
TX
Enumeration date
07/01/2006
Last updated
01/29/2015
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