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General NPI Number Information
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NPI Number | 1578477477
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Entity Type | Organization
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Legal Business Name | BRAIN INJURY REHAB DOC LLC
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 1412 HAROLD ST UNIT B
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City | HOUSTON
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State | TX
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Zip | 77006-3730
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Country | US
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Telephone | 732-939-4062
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 HAROLD ST UNIT B
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City | HOUSTON
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State | TX
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Zip | 77006-3730
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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 | HARSHA AYYALA
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Credential |
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Telephone | 732-939-4062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P0301X
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Taxonomy Name | Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State | NULL
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