Provider Demographics
NPI: | 1326614736 |
---|---|
Name: | TRUEFIX PHYSICAL THERAPY LLC |
Entity Type: | Organization |
Organization Name: | TRUEFIX PHYSICAL THERAPY LLC |
Other - Org Name: | THE LONGEVITY LOCALE |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | OWNER, PHYSICAL THERAPIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ERIC |
Authorized Official - Middle Name: | EDUARDO |
Authorized Official - Last Name: | VARGAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 913-461-7418 |
Mailing Address - Street 1: | 10561 BARKLEY ST STE 104 |
Mailing Address - Street 2: | |
Mailing Address - City: | OVERLAND PARK |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 66212-1860 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 913-461-7418 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10561 BARKLEY ST STE 104 |
Practice Address - Street 2: | |
Practice Address - City: | OVERLAND PARK |
Practice Address - State: | KS |
Practice Address - Zip Code: | 66212-1860 |
Practice Address - Country: | US |
Practice Address - Phone: | 913-461-7418 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-05-27 |
Last Update Date: | 2023-06-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |