Healthcare Provider Details

I. General information

NPI: 1144703414
Provider Name (Legal Business Name): SARAYA STEWART RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 SOUTHWEST BLVD
BENBROOK TX
76132-1080
US

IV. Provider business mailing address

3100 PREMIER DR STE 234
IRVING TX
75063-2693
US

V. Phone/Fax

Practice location:
  • Phone: 817-249-8100
  • Fax: 817-249-2215
Mailing address:
  • Phone: 972-756-1222
  • Fax: 469-374-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-18-62518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: