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General NPI Number Information
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NPI Number | 1457016966
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Entity Type | Organization
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Legal Business Name | SOURCE 1 MEDICAL INC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 8080 INDEPENDENCE PKWY STE 110A
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City | PLANO
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State | TX
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Zip | 75025-4000
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Country | US
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Telephone | 469-658-0100
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Fax | 469-658-0101
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Provider Business Mailing Address
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Address Line | PO BOX 251728
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City | PLANO
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State | TX
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Zip | 75025-1517
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Country | US
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Telephone | 972-801-2190
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Fax | 972-801-2191
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. WILLIAM GARRET HARRELL
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Credential |
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Telephone | 214-808-2724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #12
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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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