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General NPI Number Information
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NPI Number | 1538413653
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Entity Type | Organization
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Legal Business Name | SASHA MARIE RINGDAHL IVERSEN DO, PLLC
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 9432 KATY FWY STE 400
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City | HOUSTON
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State | TX
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Zip | 77055-6367
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Country | US
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Telephone | 281-912-3483
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Fax |
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Provider Business Mailing Address
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Address Line | 13702 SANDFORD LAKE CIR
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City | HOUSTON
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State | TX
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Zip | 77077-2793
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Country | US
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Telephone | 281-912-3483
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SASHA IVERSEN
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Credential | D.O.
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Telephone | 281-912-3483
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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 | P4106
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License Number State | TX
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