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General NPI Number Information
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NPI Number | 1992316806
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Entity Type | Organization
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Legal Business Name | AMP MOVEMENT THERAPY
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 4715 IBERIA AVE STE 200
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City | DALLAS
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State | TX
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Zip | 75207-5507
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Country | US
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Telephone | 913-645-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 3026 THOMAS AVE APT H
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City | DALLAS
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State | TX
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Zip | 75204-3525
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Country | US
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Telephone | 913-645-0703
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | AMELIA PONCHUR
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Credential | PT, DPT
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Telephone | 913-645-0703
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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 |
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License Number State |
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