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General NPI Number Information
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NPI Number | 1336468891
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Entity Type | Organization
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Legal Business Name | PERFORMANCE WELLNESS PHYSICAL THERAPY CENTER
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 6500 N MOPAC EXPY BLDG. 3, STE. 101
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City | AUSTIN
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State | TX
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Zip | 78731-3282
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Country | US
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Telephone | 512-491-7772
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Fax | 512-339-6806
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Provider Business Mailing Address
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Address Line | 6500 N MOPAC EXPY BLDG. 3, STE. 101
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City | AUSTIN
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State | TX
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Zip | 78731-3282
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Country | US
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Telephone | 512-491-7772
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Fax | 512-339-6806
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDIE LEACH
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Credential | D.C.
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Telephone | 512-491-7772
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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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