Provider Demographics
NPI:1346586211
Name:DURDEN PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:DURDEN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-251-9800
Mailing Address - Street 1:2415 PECAN ST W
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3669
Mailing Address - Country:US
Mailing Address - Phone:512-251-9800
Mailing Address - Fax:512-251-7900
Practice Address - Street 1:2415 PECAN ST W
Practice Address - Street 2:SUITE 400
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3669
Practice Address - Country:US
Practice Address - Phone:512-251-9800
Practice Address - Fax:512-251-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612767Medicare PIN