Provider Demographics
NPI:1760709109
Name:PREMIER PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:GALVE
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-881-1156
Mailing Address - Street 1:2824 VALLEY VIEW LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-4970
Mailing Address - Country:US
Mailing Address - Phone:817-881-1156
Mailing Address - Fax:
Practice Address - Street 1:2824 VALLEY VIEW LN
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-4970
Practice Address - Country:US
Practice Address - Phone:817-881-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1094589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB113719OtherMEDICARE PTAN