Healthcare Provider Details

I. General information

NPI: 1376323238
Provider Name (Legal Business Name): ATHLETERX PERFORMANCE REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 E PLANO PKWY STE 100C
PLANO TX
75074-1833
US

IV. Provider business mailing address

2505 WINTERSTONE DR
PLANO TX
75023-7820
US

V. Phone/Fax

Practice location:
  • Phone: 920-277-5151
  • Fax:
Mailing address:
  • Phone: 920-277-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN VOLKMAN
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 920-277-5151