Healthcare Provider Details

I. General information

NPI: 1093589962
Provider Name (Legal Business Name): THERAPY TIME HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 DWYER LN
FLOWER MOUND TX
75022-2869
US

IV. Provider business mailing address

3400 DWYER LN
FLOWER MOUND TX
75022-2869
US

V. Phone/Fax

Practice location:
  • Phone: 704-252-4563
  • Fax:
Mailing address:
  • Phone: 704-252-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NAMRATHA THIKKAVARAPU
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 704-252-4563