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General NPI Number Information
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NPI Number | 1538573746
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Entity Type | Organization
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Legal Business Name | IDEAL PHYSICAL THERAPY OF TEXAS LLC
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 4709 W PARKER RD STE 460
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City | PLANO
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State | TX
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Zip | 75093-3369
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Country | US
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Telephone | 972-979-6577
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Fax | 972-979-3369
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 630-296-2222
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Fax | 630-759-9510
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Authorized Official
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Title or Position | VP CHIEF COMPLIANCE OFFICER
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Name | WADE A MEYER
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Credential |
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Telephone | 630-296-2223
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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 | 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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