Healthcare Provider Details

I. General information

NPI: 1891388757
Provider Name (Legal Business Name): ILIANA ISABEL PRINCE PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 W UNIVERSITY DR
PROSPER TX
75078-8133
US

IV. Provider business mailing address

1970 W UNIVERSITY DR
PROSPER TX
75078-8133
US

V. Phone/Fax

Practice location:
  • Phone: 469-329-7701
  • Fax: 469-329-7898
Mailing address:
  • Phone: 469-329-7701
  • Fax: 469-329-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1342411
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: