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General NPI Number Information
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NPI Number | 1639884075
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Entity Type | Organization
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Legal Business Name | GREATER LEWISVILLE THERAPY CENTER INC
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 1010 N BELT LINE RD STE 102
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City | MESQUITE
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State | TX
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Zip | 75149-1770
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Country | US
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Telephone | 972-288-2400
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Fax | 833-234-1878
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Provider Business Mailing Address
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Address Line | 966 N GARDEN RIDGE BLVD STE 530
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City | LEWISVILLE
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State | TX
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Zip | 75077-2876
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Country | US
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Telephone | 972-420-6605
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Fax | 844-965-9627
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER-GTC
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Name | RICHARD R KELLY
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Credential | OT
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Telephone | 972-420-6605
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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 |
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License Number State |
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