Healthcare Provider Details

I. General information

NPI: 1447330832
Provider Name (Legal Business Name): MS. EINAT SHIMONI OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 N JOSEY LN
CARROLLTON TX
75010-4615
US

IV. Provider business mailing address

4780 N JOSEY LN
CARROLLTON TX
75010-4615
US

V. Phone/Fax

Practice location:
  • Phone: 972-395-2293
  • Fax: 972-395-2294
Mailing address:
  • Phone: 972-395-2293
  • Fax: 972-395-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30406
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1143113
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: