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General NPI Number Information
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NPI Number | 1437525516
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Entity Type | Organization
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Legal Business Name | PREFERRED PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 7000 PARKWOOD BLVD STE F400
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City | FRISCO
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State | TX
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Zip | 75034-7415
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Country | US
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Telephone | 440-935-2720
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 MAIN ST STE. 235-510
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City | FRISCO
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State | TX
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Zip | 75034-4411
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Country | US
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Telephone | 440-935-2720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK BRENNAN RUSSO
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Credential | DPT
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Telephone | 214-733-7869
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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 | 1178901
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License Number State | TX
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