Healthcare Provider Details

I. General information

NPI: 1356879175
Provider Name (Legal Business Name): MPOWER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 BINKLEY AVE
DALLAS TX
75205-2230
US

IV. Provider business mailing address

3434 BINKLEY AVE
DALLAS TX
75205-2230
US

V. Phone/Fax

Practice location:
  • Phone: 214-538-2559
  • Fax:
Mailing address:
  • Phone: 214-520-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1169764
License Number StateTX

VIII. Authorized Official

Name: STEFANI WYLIE CROWLEY
Title or Position: OWNER
Credential: PHYSICAL THERAPIST
Phone: 214-538-2559