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General NPI Number Information
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NPI Number | 1689085193
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Entity Type | Organization
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Legal Business Name | AXIS BRAIN AND BACK INSTITUTE PLLC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1110 E STATE HIGHWAY 114 STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5251
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Country | US
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Telephone | 817-502-7411
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Fax | 817-502-7412
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Provider Business Mailing Address
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Address Line | 1110 E STATE HIGHWAY 114 STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5251
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Country | US
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Telephone | 817-502-7411
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Fax | 817-502-7412
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SAEID ESMAEILY ARYAN
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Credential | DO
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Telephone | 817-502-7411
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | P9148
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License Number State | TX
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