1073681227 NPI number — MS. COREY DIETRICH ULRICH PT, MSPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073681227 NPI number — MS. COREY DIETRICH ULRICH PT, MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULRICH
Provider First Name:
COREY
Provider Middle Name:
DIETRICH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073681227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
966 N GARDEN RIDGE BLVD
Provider Second Line Business Mailing Address:
SUITE 530
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75077-2876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-420-6605
Provider Business Mailing Address Fax Number:
972-436-2770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W ARBROOK BLVD
Provider Second Line Business Practice Location Address:
SUITE 151
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76014-3181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-472-8383
Provider Business Practice Location Address Fax Number:
817-472-8386
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1125342 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81646T . This is a "BCBS ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1125342 . This is a "PHYSICAL THERAPIST - REGULAR LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2844359-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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