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General NPI Number Information
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NPI Number | 1588447312
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Entity Type | Organization
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Legal Business Name | IMPACT PERFORMANCE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 5420 E US HIGHWAY 377 # A
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City | GRANBURY
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State | TX
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Zip | 76049-7805
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Country | US
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Telephone | 999-869-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 E US HIGHWAY 377 # A
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City | GRANBURY
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State | TX
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Zip | 76049-7805
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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 | OWNER
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Name | BRITTANY MCCRIGHT
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Credential | PT
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Telephone | 940-782-3158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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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