MEDICARE: NEUROTHERAPY CENTER OF DALLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D2622	TX

General Provider Information

NPI Number	:	1083731335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROTHERAPY CENTER OF DALLAS

Provider Business Mailing Address
First Line	:	12870 HILLCREST RD
Second Line	:	SUITE 201
City	:	DALLAS
State	:	TX
Zip	:	75230-1531
Country	:	US
Telephone Number	:	972-991-1153
Fax Number	:	972-991-1346

Provider Business Practice Location Address
First Line	:	12870 HILLCREST RD
Second Line	:	SUITE 201
City	:	DALLAS
State	:	TX
Zip	:	75230-1531
Country	:	US
Telephone Number	:	972-991-1153
Fax Number	:	972-991-1346

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN EDWARD WALKER
Credential	:	MD
Telephone Number	:	972-991-1153

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	10/15/2007

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Directions to “NEUROTHERAPY CENTER OF DALLAS ” Practice Location

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