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General NPI Number Information
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NPI Number | 1316476609
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Entity Type | Organization
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Legal Business Name | ADVANCED NEUROMUSCULAR PERFORMANCE & PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1211 S MAIN ST STE 500
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City | KELLER
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State | TX
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Zip | 76248-0822
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Country | US
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Telephone | 770-875-4985
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 S MAIN ST STE 500
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City | KELLER
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State | TX
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Zip | 76248-0822
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Country | US
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Telephone | 770-875-4985
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER/CEO
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Name | KIMBERELY NICOLE HOLLOWAY
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Credential | DPT
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Telephone | 770-875-4985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1261798
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License Number State | TX
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