Provider Demographics
NPI:1396468047
Name:PTAC PLLC
Entity type:Organization
Organization Name:PTAC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-205-4995
Mailing Address - Street 1:456 E SANDY LAKE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2911
Mailing Address - Country:US
Mailing Address - Phone:972-393-8067
Mailing Address - Fax:972-638-8567
Practice Address - Street 1:456 E SANDY LAKE RD STE 110
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2911
Practice Address - Country:US
Practice Address - Phone:972-393-8067
Practice Address - Fax:972-638-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty