Healthcare Provider Details

I. General information

NPI: 1730702101
Provider Name (Legal Business Name): HEALING HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N OAK ST STE 220
ROANOKE TX
76262-6105
US

IV. Provider business mailing address

12460 WOODS EDGE TRL
FORT WORTH TX
76244-9408
US

V. Phone/Fax

Practice location:
  • Phone: 682-502-4440
  • Fax: 682-502-4440
Mailing address:
  • Phone: 817-637-0368
  • Fax: 682-509-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIETA K GRISSMAN
Title or Position: OWNER
Credential: PTA
Phone: 682-502-4440