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General NPI Number Information
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NPI Number | 1851563464
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Entity Type | Organization
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Legal Business Name | NEUROTRIX, INC.
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 1657 E 70TH ST
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City | SHREVEPORT
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State | LA
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Zip | 71105-5115
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Country | US
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Telephone | 318-869-8439
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Fax | 318-797-1423
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Provider Business Mailing Address
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Address Line | PO BOX 53225
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City | SHREVEPORT
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State | LA
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Zip | 71135-3225
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Country | US
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Telephone | 318-869-8439
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Fax | 318-797-1423
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Authorized Official
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Title or Position | CFO
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Name | MR. KEYVAN SHAHRDAR
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Credential |
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Telephone | 318-869-8439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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