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General NPI Number Information
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NPI Number | 1962550665
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Entity Type | Organization
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Legal Business Name | FIRRA THERAPEUTICS, LLC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 10557 CHURCH ROAD
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City | DALLAS
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State | TX
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Zip | 75238
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Country | US
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Telephone | 214-348-3516
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Fax | 214-348-5727
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Provider Business Mailing Address
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Address Line | 10557 CHURCH RD
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City | DALLAS
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State | TX
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Zip | 75238-2269
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Country | US
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Telephone | 214-348-3516
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Fax | 214-348-5727
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JOAN CRUMMEY FIRRA
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Credential | PT, PHD
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Telephone | 214-348-3516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 1001667
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License Number State | TX
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