Healthcare Provider Details

I. General information

NPI: 1902773161
Provider Name (Legal Business Name): IDEAL PHYSICAL THERAPY OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W FM 544 STE 105
MURPHY TX
75094-3715
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 972-979-6577
  • Fax: 972-979-6951
Mailing address:
  • Phone: 630-296-2222
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: WADE A MEYER
Title or Position: VP CHIEF COMPLIANCE OFFICER
Credential:
Phone: 630-296-2222