Healthcare Provider Details

I. General information

NPI: 1316489156
Provider Name (Legal Business Name): ALIGN HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S MAIN ST STE 305
GRAPEVINE TX
76051-7506
US

IV. Provider business mailing address

1025 S MAIN ST STE 305
GRAPEVINE TX
76051-7506
US

V. Phone/Fax

Practice location:
  • Phone: 817-251-0550
  • Fax: 817-251-0599
Mailing address:
  • Phone: 817-251-0550
  • Fax: 817-251-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JERRYLEE OTIMEYE EJUWA
Title or Position: OWNER
Credential: DC
Phone: 817-251-0550