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General NPI Number Information
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NPI Number | 1609230440
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Entity Type | Organization
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Legal Business Name | FITSTAR PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 17400 DALLAS PARKWAY, STE 210
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City | DALLAS
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State | TX
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Zip | 75287-7306
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Country | US
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Telephone | 469-372-5399
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Fax |
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Provider Business Mailing Address
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Address Line | 17400 DALLAS PKWY STE 210
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City | DALLAS
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State | TX
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Zip | 75287-7306
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Country | US
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Telephone | 469-372-5399
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DANAREE LYNETTE ALLGOOD
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Credential | MSPT
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Telephone | 917-684-9375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1260250
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License Number State | TX
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