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General NPI Number Information
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NPI Number | 1063655124
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Entity Type | Organization
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Legal Business Name | PYRAMID PAIN AND REHAB P.A.
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Dates
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Enumeration Date | 04/19/2009
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 1001 SARA SWAMY DR. STE 220
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City | SHERMAN
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State | TX
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Zip | 75090-3124
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Country | US
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Telephone | 903-892-1999
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Fax | 903-892-6999
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Provider Business Mailing Address
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Address Line | 1001 SARA SWAMY DR STE 220
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City | SHERMAN
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State | TX
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Zip | 75090-3124
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Country | US
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Telephone | 903-892-1999
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Fax | 903-892-6999
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Authorized Official
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Title or Position | MD
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Name | SREENADHA R. VATTAM
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Credential | MD
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Telephone | 903-892-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | M2851
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State | TX
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