Provider Demographics
NPI:1578894135
Name:IRVING MYOTHERAPY LLC
Entity Type:Organization
Organization Name:IRVING MYOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPY AND REHAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:SOBERANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-514-6278
Mailing Address - Street 1:612 N STORY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6764
Mailing Address - Country:US
Mailing Address - Phone:972-514-6278
Mailing Address - Fax:469-713-2444
Practice Address - Street 1:612 N STORY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6764
Practice Address - Country:US
Practice Address - Phone:972-514-6278
Practice Address - Fax:469-713-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty