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General NPI Number Information
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NPI Number | 1164403036
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Entity Type | Organization
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Legal Business Name | CENTRE OF PHYSICAL REHABILITATION
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2301 COIT RD SUITE B
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City | PLANO
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State | TX
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Zip | 75075-3773
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Country | US
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Telephone | 972-599-9191
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Fax | 972-599-2323
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Provider Business Mailing Address
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Address Line | 2301 COIT RD SUITE B
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City | PLANO
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State | TX
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Zip | 75075-3773
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Country | US
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Telephone | 972-599-9191
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Fax | 972-599-2323
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Authorized Official
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Title or Position | CLINIC DIRECTOR AND OWNER
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Name | PROF. SERGE BRUNO SAITHSOOTHANE
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Credential | P.T.
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Telephone | 972-599-9191
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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 | 155903
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License Number State | TX
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