Provider Demographics
NPI:1154662468
Name:PHYSIOTHERAPY ASC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASC
Other - Org Name:MATRIX NORTH DALLAS PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMPHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-437-2048
Mailing Address - Street 1:510 N COIT RD
Mailing Address - Street 2:2035 PROMENADE CTR
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5446
Mailing Address - Country:US
Mailing Address - Phone:972-437-2048
Mailing Address - Fax:972-480-8514
Practice Address - Street 1:510 N COIT RD
Practice Address - Street 2:2035 PROMENADE CTR
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5446
Practice Address - Country:US
Practice Address - Phone:972-437-2048
Practice Address - Fax:972-480-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112244261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine