MEDICARE: PHYSICAL REHABILITATION NETWORK LLC

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	:	1699505305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL REHABILITATION NETWORK LLC

Provider Business Mailing Address
First Line	:	2600 DALLAS PKWY STE 290
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-7493
Country	:	US
Telephone Number	:	945-050-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 DALLAS PKWY STE 290
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-7493
Country	:	US
Telephone Number	:	945-050-0010
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ROBERT PACE
Credential	:
Telephone Number	:	945-260-0010

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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