Provider Demographics
NPI:1255905485
Name:OHRADZANSKY, PAYTON NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:NICOLE
Last Name:OHRADZANSKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8607
Mailing Address - Country:US
Mailing Address - Phone:972-724-2400
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:3001 STATE HIGHWAY 121 STE 292
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5800
Practice Address - Country:US
Practice Address - Phone:817-684-0397
Practice Address - Fax:817-684-8253
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1357024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist