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General NPI Number Information
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NPI Number | 1114692597
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Entity Type | Organization
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Legal Business Name | ELITE ALLIANCE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 2629 N STEMMONS FWY STE 225
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City | DALLAS
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State | TX
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Zip | 75207-2115
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Country | US
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Telephone | 469-531-9697
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 POPPY HILL CT
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City | ROWLETT
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State | TX
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Zip | 75088-6496
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Country | US
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Telephone | 469-531-9697
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | DR. EMMANUEL FASANYA JR.
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Credential | PT, DPT, CSOMT
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Telephone | 469-531-9697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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