Healthcare Provider Details

I. General information

NPI: 1578038428
Provider Name (Legal Business Name): 180 THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E INTERSTATE 30 STE B
ROYSE CITY TX
75189-3131
US

IV. Provider business mailing address

422 E INTERSTATE 30 STE C
ROYSE CITY TX
75189-3131
US

V. Phone/Fax

Practice location:
  • Phone: 972-532-0448
  • Fax: 833-358-0263
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHASE AARON RANDOLPH
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 972-532-0448