Healthcare Provider Details

I. General information

NPI: 1376479600
Provider Name (Legal Business Name): PRIMAL SHIFT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 KAUFFMAN LOOP UNIT 410
GEORGETOWN TX
78628-1461
US

IV. Provider business mailing address

113 COASTAL WAY
GEORGETOWN TX
78628-1939
US

V. Phone/Fax

Practice location:
  • Phone: 512-200-4469
  • Fax: 512-233-5875
Mailing address:
  • Phone: 512-200-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNE REHLER VINCENT
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 512-584-9011