Provider Demographics
NPI:1235679242
Name:ALLIED PHYSICAL MEDICINE, PA
Entity Type:Organization
Organization Name:ALLIED PHYSICAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:214-547-7234
Mailing Address - Street 1:309 S JUPITER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3052
Mailing Address - Country:US
Mailing Address - Phone:214-547-7234
Mailing Address - Fax:214-547-7236
Practice Address - Street 1:1930 RAWHIDE DR STE 308
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6954
Practice Address - Country:US
Practice Address - Phone:214-547-7234
Practice Address - Fax:214-547-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty