Provider Demographics
NPI:1427587302
Name:GILEAD SPINE AND SPORTS MANUAL THERAPY CENTER
Entity Type:Organization
Organization Name:GILEAD SPINE AND SPORTS MANUAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:469-298-2318
Mailing Address - Street 1:3326 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-3365
Mailing Address - Country:US
Mailing Address - Phone:469-298-2318
Mailing Address - Fax:
Practice Address - Street 1:3326 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-3365
Practice Address - Country:US
Practice Address - Phone:469-298-2318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10404422251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184953648OtherNPI