Provider Demographics
NPI:1952659724
Name:ROYAL CROWN HEALTHCARE PROVIDER INCORPORATED
Entity Type:Organization
Organization Name:ROYAL CROWN HEALTHCARE PROVIDER INCORPORATED
Other - Org Name:A1 PHYSICAL THERAPY CLINIC OF IRVING AT LAS COLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINU
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:214-492-3947
Mailing Address - Street 1:1208 CEDAR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4415
Mailing Address - Country:US
Mailing Address - Phone:214-492-3947
Mailing Address - Fax:972-506-3007
Practice Address - Street 1:1300 W WALNUT HILL LN
Practice Address - Street 2:SUITE- 240
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3000
Practice Address - Country:US
Practice Address - Phone:214-492-3947
Practice Address - Fax:972-506-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNOT AVAILABLE261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy