1518097328 NPI number — PHYSIOTHERAPY ASSOCIATES INC

Table of content: (NPI 1518097328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518097328 NPI number — PHYSIOTHERAPY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIOTHERAPY ASSOCIATES 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:
1518097328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 COIT RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-3769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-467-8705
Provider Business Mailing Address Fax Number:
267-321-2550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 S LINCOLN AVE
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60505-4290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-844-4284
Provider Business Practice Location Address Fax Number:
630-844-4565
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POOL
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
FLECK
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
469-467-8705

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  070.007178 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1636250 . This is a "BCBS PROVIDOR #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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