=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790343077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FYZICAL THERAPY AND BALANCE CENTERS- PLANO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2019
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5804 COIT RD STE 108
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75023-5957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-799-9949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9236 OLD VERANDA RD
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-7082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-808-6338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NANDITA SHAH
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 312-799-9949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------