Provider Demographics
NPI:1043665367
Name:KNEAD PHYSICAL MEDICINE PA
Entity Type:Organization
Organization Name:KNEAD PHYSICAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCE DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-448-1066
Mailing Address - Street 1:4944 PRESTON RD
Mailing Address - Street 2:STE 100A
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8597
Mailing Address - Country:US
Mailing Address - Phone:469-304-3443
Mailing Address - Fax:
Practice Address - Street 1:4944 PRESTON RD
Practice Address - Street 2:STE 100A
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8597
Practice Address - Country:US
Practice Address - Phone:469-304-3443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty