MEDICARE: LEGENDARY HEIGHTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1205632205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGENDARY HEIGHTS LLC

Provider Business Mailing Address
First Line	:	653 MEADOWBROOK ST
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-4731
Country	:	US
Telephone Number	:	580-740-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	653 MEADOWBROOK ST
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-4731
Country	:	US
Telephone Number	:	580-740-1169
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANRICH KRUGER
Credential	:
Telephone Number	:	580-740-1169

Provider Enumeration Date	:	02/20/2025
Last Update Date	:	02/20/2025

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Directions to “LEGENDARY HEIGHTS LLC ” Practice Location

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