Healthcare Provider Details

I. General information

NPI: 1760809040
Provider Name (Legal Business Name): ROOT NEURODIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 ZENOBIA ST
DENVER CO
80212-2235
US

IV. Provider business mailing address

PO BOX 1288
CROSBY TX
77532-1288
US

V. Phone/Fax

Practice location:
  • Phone: 281-324-5660
  • Fax: 281-324-5679
Mailing address:
  • Phone: 281-324-5660
  • Fax: 281-324-5679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: TYLER ROOT
Title or Position: OWNER
Credential:
Phone: 281-324-5660