Healthcare Provider Details

I. General information

NPI: 1538354972
Provider Name (Legal Business Name): UPTOWN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4209 MCKINNEY AVE SUITE 203
DALLAS TX
75205-4509
US

IV. Provider business mailing address

4209 MCKINNEY AVE SUITE 203
DALLAS TX
75205-4509
US

V. Phone/Fax

Practice location:
  • Phone: 214-219-3334
  • Fax: 214-219-3448
Mailing address:
  • Phone: 214-219-3334
  • Fax: 214-219-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1076933
License Number StateTX

VIII. Authorized Official

Name: MS. PATRICIA ELLEN HORTON
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 214-219-3334