Healthcare Provider Details

I. General information

NPI: 1508036963
Provider Name (Legal Business Name): EXPRESSIONS PAIN AND REHAB, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2008
Last Update Date: 03/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W FM 1382
CEDAR HILL TX
75104-5322
US

IV. Provider business mailing address

PO BOX 222093
DALLAS TX
75222-2093
US

V. Phone/Fax

Practice location:
  • Phone: 972-291-9165
  • Fax:
Mailing address:
  • Phone: 972-291-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL9668
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberL9668
License Number StateTX

VIII. Authorized Official

Name: DR. BENJAMIN CHARLES DAGLEY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 972-291-9165