Healthcare Provider Details

I. General information

NPI: 1790343077
Provider Name (Legal Business Name): FYZICAL THERAPY AND BALANCE CENTERS- PLANO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5804 COIT RD STE 108
PLANO TX
75023-5957
US

IV. Provider business mailing address

9236 OLD VERANDA RD
PLANO TX
75024-7082
US

V. Phone/Fax

Practice location:
  • Phone: 312-799-9949
  • Fax:
Mailing address:
  • Phone: 972-808-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NANDITA SHAH
Title or Position: OWNER
Credential: PT
Phone: 312-799-9949