1285718544 NPI number — PRESSLER PHYSICAL THERAPY CLINIC

Table of content: (NPI 1285718544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285718544 NPI number — PRESSLER PHYSICAL THERAPY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESSLER PHYSICAL THERAPY CLINIC
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:
1285718544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 W WHEATLAND RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
DUNCANVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75116-4600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-709-9191
Provider Business Mailing Address Fax Number:
972-709-2116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 W WHEATLAND RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
DUNCANVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75116-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-709-9191
Provider Business Practice Location Address Fax Number:
972-709-2116
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRESSLER
Authorized Official First Name:
DALE
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-709-9191

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1022390 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: 1023869 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0941745 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0876389501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5445569 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 80251T . This is a "BLUECROSS BLUE SHEILD #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0044169 . This is a "BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4366891 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7369351 . This is a "BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 80250T . This is a "BLUECROSS BLUE SHEILD #" identifier . This identifiers is of the category "OTHER".




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