Provider Demographics
NPI:1346619509
Name:FUNCTIONAL IMPROVEMENT THERAPY LLC
Entity Type:Organization
Organization Name:FUNCTIONAL IMPROVEMENT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TUYEN
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-473-4348
Mailing Address - Street 1:3213 RIDGE TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5365
Mailing Address - Country:US
Mailing Address - Phone:817-808-5353
Mailing Address - Fax:
Practice Address - Street 1:4200 SW GREEN OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4162
Practice Address - Country:US
Practice Address - Phone:817-478-5800
Practice Address - Fax:817-478-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty