MEDICARE: BACK 2 LIFE PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1106250	TX

General Provider Information

NPI Number	:	1013137975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK 2 LIFE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	7502 GREENVILLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:	214-369-7881
Fax Number	:	214-369-7882

Provider Business Practice Location Address
First Line	:	7502 GREENVILLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:	214-369-7881
Fax Number	:	214-369-7882

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KYLA SUE KILLIAN
Credential	:	P.T.
Telephone Number	:	469-438-6058

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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Directions to “BACK 2 LIFE PHYSICAL THERAPY ” Practice Location

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