Healthcare Provider Details

I. General information

NPI: 1427555366
Provider Name (Legal Business Name): ANISH G ABRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 04/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9009 WHITE ROCK TRL
DALLAS TX
75238-3347
US

IV. Provider business mailing address

308 STONE RIDGE DR
SUNNYVALE TX
75182-2627
US

V. Phone/Fax

Practice location:
  • Phone: 516-581-9221
  • Fax:
Mailing address:
  • Phone: 516-581-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number116530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: