Provider Demographics
NPI:1164403036
Name:CENTRE OF PHYSICAL REHABILITATION
Entity Type:Organization
Organization Name:CENTRE OF PHYSICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR AND OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:BRUNO
Authorized Official - Last Name:SAITHSOOTHANE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-599-9191
Mailing Address - Street 1:2301 COIT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3773
Mailing Address - Country:US
Mailing Address - Phone:972-599-9191
Mailing Address - Fax:972-599-2323
Practice Address - Street 1:2301 COIT RD
Practice Address - Street 2:SUITE B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3773
Practice Address - Country:US
Practice Address - Phone:972-599-9191
Practice Address - Fax:972-599-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0895OtherBCBS PROVIDER ID
TX0027019OtherBLUE LINK NUMBER
TX00000093JNOtherBCBS GROUP PROVIDER ID
TX8T0895OtherBCBS PROVIDER ID