1417508730 NPI number — AVIATOR REHAB SPECIALISTS LLC

Table of content: (NPI 1417508730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417508730 NPI number — AVIATOR REHAB SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVIATOR REHAB SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVIATOR SPORTS PERFORMANCE & REHABILITATION
Provider Other Organization Name Type Code:
3
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:
1417508730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 RAY WHITE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76244-9105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-961-4920
Provider Business Mailing Address Fax Number:
469-250-8488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6151 COUNTY ROAD 124
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75071-4837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-645-1833
Provider Business Practice Location Address Fax Number:
972-645-1834
Provider Enumeration Date:
09/27/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HAAS
Authorized Official First Name:
CARL
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTS & OPERATIONS SENIOR EXEC
Authorized Official Telephone Number:
972-961-4920

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 686000000 . This is a "EXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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