1063273563 NPI number — PARAGON CARE OUTPATIENT PT LLC

Table of content: (NPI 1063273563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063273563 NPI number — PARAGON CARE OUTPATIENT PT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGON CARE OUTPATIENT PT 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:
Provider Other Organization Name Type Code:
6
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:
1063273563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 GRANDVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75223-1504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-748-9559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8330 ABRAMS RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-7590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-850-1851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BOOTH
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PT, DPT/ OWNER
Authorized Official Telephone Number:
214-850-1851

Provider Taxonomy Codes

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

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

  • Identifier: 1114798439 . This is a "PHYSICAL THERAPY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com