Healthcare Provider Details

I. General information

NPI: 1699557009
Provider Name (Legal Business Name): IPA PHYSIO DALLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 RASOR BLVD STE 243
PLANO TX
75024-0341
US

IV. Provider business mailing address

8105 RASOR BLVD STE 243
PLANO TX
75024-0341
US

V. Phone/Fax

Practice location:
  • Phone: 469-782-9978
  • Fax: 469-782-9946
Mailing address:
  • Phone: 469-782-9978
  • Fax: 469-782-9946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JIMMY ARMENTROUT
Title or Position: PRESIDENT
Credential: PT
Phone: 972-965-7128