Provider Demographics
NPI:1013554849
Name:LITTLE ELM PHYSICAL REHAB CENTER, LLC.
Entity Type:Organization
Organization Name:LITTLE ELM PHYSICAL REHAB CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:W
Authorized Official - Last Name:LONGWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-987-4672
Mailing Address - Street 1:1395 E ELDORADO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5508
Mailing Address - Country:US
Mailing Address - Phone:972-987-4672
Mailing Address - Fax:972-987-4693
Practice Address - Street 1:1395 EAST EL DORADO PKWAY
Practice Address - Street 2:SUITE # 110
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-3346
Practice Address - Country:US
Practice Address - Phone:561-729-9302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty