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General NPI Number Information
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NPI Number | 1184369191
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Entity Type | Organization
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Legal Business Name | FAMILY TREE COMMUNITY CARE
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 2109 W PARKER RD STE 208
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City | PLANO
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State | TX
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Zip | 75023-7739
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Country | US
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Telephone | 214-230-0054
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 W PARKER RD STE 208
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City | PLANO
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State | TX
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Zip | 75023-7739
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Country | US
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Telephone | 214-230-0054
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ABI BALOGUN
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Credential | PT
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Telephone | 972-514-4032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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