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General NPI Number Information
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NPI Number | 1902122179
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Entity Type | Organization
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Legal Business Name | EXOS - ATHLETES PERFORMANCE TEXAS, LLC
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 6155 SPORTS VILLAGE RD SUITE 400
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City | FRISCO
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State | TX
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Zip | 75033-3577
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Country | US
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Telephone | 214-618-3246
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Fax | 214-618-3249
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Provider Business Mailing Address
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Address Line | 6155 SPORTS VILLAGE RD SUITE 400
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City | FRISCO
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State | TX
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Zip | 75033-3577
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Country | US
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Telephone | 214-618-3246
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Fax | 214-618-3249
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Authorized Official
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Title or Position | DIRECTOR, PHYSICAL THERAPY
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Name | SHERI WALTERS
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Credential | PT
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Telephone | 214-618-3246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 668360000
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License Number State | TX
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