MEDICARE: MOSALLAIE REHAB ASSOCIATES, P.A.

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	208100000X	Physical Medicine & Rehabilitation Physician	L9821	TX

General Provider Information

NPI Number	:	1912943879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSALLAIE REHAB ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	5225 MAPLE AVE
Second Line	:	3101
City	:	DALLAS
State	:	TX
Zip	:	75235-8195
Country	:	US
Telephone Number	:	214-727-1180
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 MAPLE AVE
Second Line	:	3101
City	:	DALLAS
State	:	TX
Zip	:	75235-8195
Country	:	US
Telephone Number	:	214-727-1180
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEIKHOSROW MOSALLAIE
Credential	:	D.O., PH.D.
Telephone Number	:	214-727-1180

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	08/22/2020

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