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General NPI Number Information
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NPI Number | 1952643074
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Entity Type | Organization
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Legal Business Name | EDGE REHABILITATION AND WELLNESS - MCKINNEY, LLC
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 5305 W. UNIVERSITY DR.
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City | MCKINNEY
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State | TX
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Zip | 75071
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Country | US
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Telephone | 972-529-9292
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Fax | 972-529-9293
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Provider Business Mailing Address
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Address Line | 5305 W UNIVERSITY DR.
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City | MCKINNEY
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State | TX
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Zip | 75071
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Country | US
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Telephone | 972-529-9292
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Fax | 972-529-9293
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | SHANE HERNANDEZ
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Credential | MPT
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Telephone | 480-580-9532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1139004
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License Number State | TX
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