Provider Demographics
NPI:1508938218
Name:GREATER LEWISVILLE THERAPY CENTER INC
Entity Type:Organization
Organization Name:GREATER LEWISVILLE THERAPY CENTER INC
Other - Org Name:GREATER THERAPY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICE-GTC
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:K
Authorized Official - Last Name:AITKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-420-6605
Mailing Address - Street 1:966 N GARDEN RIDGE BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2827
Mailing Address - Country:US
Mailing Address - Phone:972-420-6605
Mailing Address - Fax:972-436-2770
Practice Address - Street 1:966 N GARDEN RIDGE BLVD
Practice Address - Street 2:SUITE 530
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2827
Practice Address - Country:US
Practice Address - Phone:972-420-6605
Practice Address - Fax:972-436-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619640000225100000X
TX519650000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00466EMedicare PIN
TX5927900001Medicare NSC