Healthcare Provider Details

I. General information

NPI: 1932516846
Provider Name (Legal Business Name): NEUROASSESSMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 BRIDGE STREET SUITE 500
FT. WORTH TX
76112
US

IV. Provider business mailing address

POB 141866
DALLAS TX
75218
US

V. Phone/Fax

Practice location:
  • Phone: 972-570-8200
  • Fax: 972-570-8933
Mailing address:
  • Phone: 972-570-8200
  • Fax: 972-570-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number21788
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21788
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberJ7609
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberK3679
License Number StateTX

VIII. Authorized Official

Name: ZACHARY B HEATH
Title or Position: PRESIDENT
Credential:
Phone: 817-797-5020