Healthcare Provider Details

I. General information

NPI: 1922448307
Provider Name (Legal Business Name): DALLAS NEUROREHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PRESTON RD STE 300
PLANO TX
75093-3603
US

IV. Provider business mailing address

1400 PRESTON RD STE 300
PLANO TX
75093-3603
US

V. Phone/Fax

Practice location:
  • Phone: 469-931-2229
  • Fax: 214-614-4610
Mailing address:
  • Phone: 469-931-2229
  • Fax: 214-614-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number33993
License Number StateTX

VIII. Authorized Official

Name: DR. JULIAN OSUJI
Title or Position: OWNER
Credential: PHD
Phone: 469-931-2229