Provider Demographics
NPI:1659303246
Name:WATERMARK PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:WATERMARK PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-378-6868
Mailing Address - Street 1:2845 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4574
Mailing Address - Country:US
Mailing Address - Phone:972-378-6868
Mailing Address - Fax:214-279-0738
Practice Address - Street 1:2845 PARKWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4574
Practice Address - Country:US
Practice Address - Phone:972-378-6868
Practice Address - Fax:214-279-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00626YMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER