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General NPI Number Information
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NPI Number | 1992323067
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Entity Type | Organization
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Legal Business Name | FREEDOM PHYSICAL THERAPY & FITNESS
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 11471 E LOOP 1604 N STE 101
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3960
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Country | US
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Telephone | 210-428-7845
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 FOREST VALE
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City | LIVE OAK
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State | TX
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Zip | 78233-7217
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Country | US
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Telephone | 607-759-3792
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHRYN NICOLE FAZIO
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Credential | PT, DPT
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Telephone | 210-428-7845
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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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