MEDICARE: ATHLETERX PERFORMANCE REHAB

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	2251S0007X	Sports Physical Therapist

General Provider Information

NPI Number	:	1376323238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETERX PERFORMANCE REHAB

Provider Business Mailing Address
First Line	:	2505 WINTERSTONE DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-7820
Country	:	US
Telephone Number	:	920-277-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 E PLANO PKWY STE 100C
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-1833
Country	:	US
Telephone Number	:	920-277-5151
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	BENJAMIN VOLKMAN
Credential	:	PT, DPT
Telephone Number	:	920-277-5151

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	09/28/2023

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Directions to “ATHLETERX PERFORMANCE REHAB ” Practice Location

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