MEDICARE: GREATER LEWISVILLE THERAPY CENTER INC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1114146974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER LEWISVILLE THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	966 N GARDEN RIDGE BLVD
Second Line	:	STE 530
City	:	LEWISVILLE
State	:	TX
Zip	:	75077
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3423 TRINITY MILLS RD STE 520
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-6280
Country	:	US
Telephone Number	:	972-662-1700
Fax Number	:	844-364-1301

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER-GTC
Name	:	MRS. DENA K AITKEN
Credential	:	PT
Telephone Number	:	972-420-6605

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/17/2021

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