Healthcare Provider Details

I. General information

NPI: 1487955381
Provider Name (Legal Business Name): ANNETTE BIELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 RIVER BEND DR
DALLAS TX
75247-4914
US

IV. Provider business mailing address

1380 RIVER BEND DR
DALLAS TX
75247-4914
US

V. Phone/Fax

Practice location:
  • Phone: 214-743-1297
  • Fax:
Mailing address:
  • Phone: 214-743-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number104380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: