Provider Demographics
NPI:1356178032
Name:PRO THERAPY SOURCE LLC
Entity type:Organization
Organization Name:PRO THERAPY SOURCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATEFEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJIALIKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-478-4664
Mailing Address - Street 1:5325 CORINTHIAN BAY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16135 PRESTON RD STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-8516
Practice Address - Country:US
Practice Address - Phone:214-478-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health