Provider Demographics
NPI:1114212065
Name:LONE STAR PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:LONE STAR PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULENWIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:214-884-9695
Mailing Address - Street 1:10455 N CENTRAL EXPY # 109-122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2213
Mailing Address - Country:US
Mailing Address - Phone:214-884-9695
Mailing Address - Fax:877-884-4589
Practice Address - Street 1:10300 N CENTRAL EXPY STE 171
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8637
Practice Address - Country:US
Practice Address - Phone:214-884-9695
Practice Address - Fax:877-884-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670770000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy