1033693072 NPI number — ON CALL PHYSICAL THERAPY AND WELLNESS, LLC

Table of content: (NPI 1033693072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033693072 NPI number — ON CALL PHYSICAL THERAPY AND WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON CALL PHYSICAL THERAPY AND WELLNESS, 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:
ON CALL THERAPY SERVICES
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:
1033693072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2109 W PARKER RD STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75023-7739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-230-2040
Provider Business Mailing Address Fax Number:
214-230-2041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2109 W PARKER RD STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75023-7739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-230-2040
Provider Business Practice Location Address Fax Number:
214-230-2041
Provider Enumeration Date:
09/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BALOGUN
Authorized Official First Name:
ABI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
214-230-2040

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4201840 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".