1710129192 NPI number — STAY STRONG PHYSICAL THERAPY - ARGYLE PLLC

Table of content: (NPI 1710129192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710129192 NPI number — STAY STRONG PHYSICAL THERAPY - ARGYLE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAY STRONG PHYSICAL THERAPY - ARGYLE PLLC
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:
1710129192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 372
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARGYLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76226-0372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-464-0055
Provider Business Mailing Address Fax Number:
940-464-7755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4809 COLE AVE STE 110
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:
75205-3553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-464-0055
Provider Business Practice Location Address Fax Number:
940-464-7755
Provider Enumeration Date:
03/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BRAZIEL
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
940-464-0055

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1161898 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0073QK . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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