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General NPI Number Information
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NPI Number | 1205642121
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Entity Type | Organization
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Legal Business Name | ATHLETE RESTORATION LAB, LLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 6155 SPORTS VILLAGE RD STE 400
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City | FRISCO
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State | TX
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Zip | 75033-3578
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Country | US
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Telephone | 877-735-2201
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Fax |
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Provider Business Mailing Address
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Address Line | 6155 SPORTS VILLAGE RD STE 400
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City | FRISCO
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State | TX
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Zip | 75033-3578
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JARED GILLESPIE
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Credential | PT
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Telephone | 913-620-0040
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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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