MEDICARE: CONSTANCE R FLEMING PT

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	225100000X	Physical Therapist	3112540	TX

General Provider Information

NPI Number	:	1780933630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE R FLEMING PT

Provider Business Mailing Address
First Line	:	160 E VISTA RIDGE MALL DR APT 425
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3719
Country	:	US
Telephone Number	:	214-546-5820
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 W CAMP WISDOM RD STE 131
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2600
Country	:	US
Telephone Number	:	214-339-4533
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	09/06/2012

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