Healthcare Provider Details

I. General information

NPI: 1437761178
Provider Name (Legal Business Name): WOWYFITNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2020
Last Update Date: 05/07/2024
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WALNUT ST STE 109
RICHARDSON TX
75081-5584
US

IV. Provider business mailing address

4214 HIGH STAR LN
DALLAS TX
75287-6624
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-3473
  • Fax: 469-784-9424
Mailing address:
  • Phone: 972-899-3473
  • Fax: 469-784-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LARRY HERNANDEZ
Title or Position: OWNER/PTA
Credential: LPTA
Phone: 972-899-3473