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General NPI Number Information
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NPI Number | 1558739342
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Entity Type | Organization
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Legal Business Name | PREMIER REHAB PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 4120 HERITAGE TRACE PKWY STE 220
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City | KELLER
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State | TX
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Zip | 76248
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Country | US
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Telephone | 817-741-7585
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 HERITAGE TRACE PKWY STE 220
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City | KELLER
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State | TX
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Zip | 76248
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Country | US
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Telephone | 817-741-7585
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MARIA UNDERWOOD
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Credential |
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Telephone | 817-200-7445
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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 | 1263891
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License Number State | TX
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