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General NPI Number Information
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NPI Number | 1376479600
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Entity Type | Organization
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Legal Business Name | PRIMAL SHIFT PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 2029 KAUFFMAN LOOP UNIT 410
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City | GEORGETOWN
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State | TX
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Zip | 78628-1461
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Country | US
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Telephone | 512-200-4469
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Fax | 512-233-5875
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Provider Business Mailing Address
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Address Line | 113 COASTAL WAY
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City | GEORGETOWN
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State | TX
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Zip | 78628-1939
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Country | US
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Telephone | 512-200-4469
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | ANNE REHLER VINCENT
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Credential | PT, DPT
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Telephone | 512-584-9011
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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 |
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License Number State |
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