MEDICARE: ALLIED PHYSICAL MEDICINE, PA

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1447610639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED PHYSICAL MEDICINE, PA

Provider Business Mailing Address
First Line	:	309 S JUPITER RD STE 100
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-3052
Country	:	US
Telephone Number	:	214-547-7234
Fax Number	:	214-547-7236

Provider Business Practice Location Address
First Line	:	2800 DALLAS PKWY STE 150
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4940
Country	:	US
Telephone Number	:	214-547-7234
Fax Number	:	214-547-7236

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DR. KENNETH R WILSON II
Credential	:	D.C.
Telephone Number	:	214-547-7234

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	07/21/2022

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Directions to “ALLIED PHYSICAL MEDICINE, PA ” Practice Location

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