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General NPI Number Information
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NPI Number | 1568691053
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Entity Type | Organization
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Legal Business Name | JEFFREY LONGINO PHYSICAL THERAPY SERVICES LLC
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 555 REPUBLIC DR STE 200
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City | PLANO
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State | TX
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Zip | 75074-5469
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Country | US
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Telephone | 469-288-0018
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Fax |
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Provider Business Mailing Address
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Address Line | 5713 SAINT THOMAS DR
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City | PLANO
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State | TX
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Zip | 75094-4618
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JEFFREY LONGINO
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Credential |
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Telephone | 469-288-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1187388
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License Number State | TX
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