Healthcare Provider Details

I. General information

NPI: 1497878383
Provider Name (Legal Business Name): AMIGOS THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 DILIDO RD SUITE 134
DALLAS TX
75228-8337
US

IV. Provider business mailing address

4212 LAVACA DR
PLANO TX
75074-3501
US

V. Phone/Fax

Practice location:
  • Phone: 214-727-6225
  • Fax: 972-509-8937
Mailing address:
  • Phone: 469-366-4877
  • Fax: 972-509-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1081669
License Number StateTX

VIII. Authorized Official

Name: RUBEN NEIRA
Title or Position: ADMINISTRATOR
Credential: PT
Phone: 214-727-6225