1972722734 NPI number — GREATER LEWISVILLE THERAPY CENTER INC

Table of content: (NPI 1972722734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972722734 NPI number — GREATER LEWISVILLE THERAPY CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER LEWISVILLE THERAPY CENTER INC
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:
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:
1972722734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2021
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:
STE 530
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75077-2827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-420-6605
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2309 VIRGINIA PARKWAY
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-542-7360
Provider Business Practice Location Address Fax Number:
844-364-1300
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AITKEN
Authorized Official First Name:
DENA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIEF OPERATING OFFICER-GTC
Authorized Official Telephone Number:
972-420-6605

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com