Provider Demographics
NPI:1609230440
Name:FITSTAR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FITSTAR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANAREE
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:ALLGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:917-684-9375
Mailing Address - Street 1:17400 DALLAS PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7306
Mailing Address - Country:US
Mailing Address - Phone:469-372-5399
Mailing Address - Fax:
Practice Address - Street 1:17400 DALLAS PARKWAY,
Practice Address - Street 2:STE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7306
Practice Address - Country:US
Practice Address - Phone:469-372-5399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1260250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty