1093753733 NPI number — PHYSIOTHERAPY ASSOCIATES INC

Table of content: (NPI 1093753733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093753733 NPI number — PHYSIOTHERAPY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIOTHERAPY ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093753733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 COIT RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-3768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-467-9870
Provider Business Mailing Address Fax Number:
267-321-2550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OAK RIDGE TPKE
Provider Second Line Business Practice Location Address:
SUITE C102
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-6957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-483-7790
Provider Business Practice Location Address Fax Number:
865-483-7791
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BINSTEIN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
610-644-7824

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0446557 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 644001 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0626451 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4090412 . This is a "BLUECROSS/BLUESHIED/TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5186150 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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