Provider Demographics
NPI:1457966202
Name:PREMIER PHYSICAL THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:DIANNA
Authorized Official - Last Name:SITARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:832-552-7120
Mailing Address - Street 1:108 ESSLEMONT
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-5164
Mailing Address - Country:US
Mailing Address - Phone:832-552-1720
Mailing Address - Fax:832-995-0174
Practice Address - Street 1:108 ESSLEMONT
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015-5164
Practice Address - Country:US
Practice Address - Phone:832-552-1720
Practice Address - Fax:832-995-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073450OtherLICENSE