Healthcare Provider Details

I. General information

NPI: 1700352614
Provider Name (Legal Business Name): ROOT PHYSICAL THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 04/07/2021
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 RASOR BLVD STE 304
PLANO TX
75024-0267
US

IV. Provider business mailing address

8105 RASOR BLVD STE 304
PLANO TX
75024-0267
US

V. Phone/Fax

Practice location:
  • Phone: 469-717-0329
  • Fax: 469-717-0327
Mailing address:
  • Phone: 469-717-0329
  • Fax: 469-717-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: AMBER NIKOLE BROWN
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: PT
Phone: 469-717-0329