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General NPI Number Information
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NPI Number | 1164133005
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Entity Type | Organization
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Legal Business Name | IRVINE PHYSIATRY PLLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2400 ROUND ROCK AVE
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City | ROUND ROCK
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State | TX
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Zip | 78681-4004
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Country | US
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Telephone | 737-219-8337
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Fax | 877-260-0030
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Provider Business Mailing Address
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Address Line | 3571 FAR WEST BLVD # 3721
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City | AUSTIN
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State | TX
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Zip | 78731-3064
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL IRVINE
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Credential |
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Telephone | 737-219-8337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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