Provider Demographics
NPI:1609163104
Name:PROMO TX, LLC
Entity Type:Organization
Organization Name:PROMO TX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-792-3460
Mailing Address - Street 1:2704 SHERRILL PARK CT
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3213
Mailing Address - Country:US
Mailing Address - Phone:858-792-3460
Mailing Address - Fax:858-792-3461
Practice Address - Street 1:2704 SHERRILL PARK CT
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3213
Practice Address - Country:US
Practice Address - Phone:858-792-3460
Practice Address - Fax:858-792-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty