Healthcare Provider Details

I. General information

NPI: 1770311375
Provider Name (Legal Business Name): PRO SPORT PERFORMANCE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7511 MAIN ST STE 170
FRISCO TX
75034-5314
US

IV. Provider business mailing address

7511 MAIN ST STE 170
FRISCO TX
75034-5314
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-8289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS ANDREAS
Title or Position: OWNER/THERAPIST
Credential: DPT
Phone: 952-250-1158