MEDICARE: STRIBLING PT PLANO 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
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1982321667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIBLING PT PLANO LLC

Provider Business Mailing Address
First Line	:	1729 N CENTRAL EXPY STE A
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-6977
Country	:	US
Telephone Number	:	469-786-0005
Fax Number	:	469-786-0019

Provider Business Practice Location Address
First Line	:	1729 N CENTRAL EXPY STE A
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-6977
Country	:	US
Telephone Number	:	469-786-0005
Fax Number	:	469-786-0019

Authorized Official
Title or Position	:	OWNER
Name	:	BLAINE STRIBLING
Credential	:
Telephone Number	:	469-786-0005

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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Directions to “STRIBLING PT PLANO LLC ” Practice Location

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