Healthcare Provider Details

I. General information

NPI: 1144335001
Provider Name (Legal Business Name): DAIRAN TALLEY MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 E COMMON ST STE 400
NEW BRAUNFELS TX
78130-6079
US

IV. Provider business mailing address

1744 E COMMON ST STE 400
NEW BRAUNFELS TX
78130-6079
US

V. Phone/Fax

Practice location:
  • Phone: 830-620-4922
  • Fax: 830-625-1194
Mailing address:
  • Phone: 830-620-4922
  • Fax: 830-625-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1135531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: