Healthcare Provider Details

I. General information

NPI: 1922820554
Provider Name (Legal Business Name): GRETTA SOPHIA HOTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 PRESTON RD STE 2074
PLANO TX
75093
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242
US

V. Phone/Fax

Practice location:
  • Phone: 972-905-6622
  • Fax: 972-942-4073
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1401736
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: