Healthcare Provider Details

I. General information

NPI: 1912608647
Provider Name (Legal Business Name): NEAL S BIRAK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 W BAY AREA BLVD
WEBSTER TX
77598-4066
US

IV. Provider business mailing address

1502 TYLER POINT LN
HOUSTON TX
77089-1452
US

V. Phone/Fax

Practice location:
  • Phone: 713-497-6931
  • Fax:
Mailing address:
  • Phone: 713-497-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1194696
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: