Healthcare Provider Details

I. General information

NPI: 1790727576
Provider Name (Legal Business Name): THERAPYCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 LYNDON B JOHNSON FWY STE. 380
DALLAS TX
75240-6304
US

IV. Provider business mailing address

3844 MARTHA LN
DALLAS TX
75229-6126
US

V. Phone/Fax

Practice location:
  • Phone: 214-351-2299
  • Fax:
Mailing address:
  • Phone: 214-351-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6132700
License Number StateTX

VIII. Authorized Official

Name: KATHLEEN TISKO
Title or Position: OWNER/ADMINISTRATOR
Credential: P.T.
Phone: 214-351-2299