Provider Demographics
NPI:1700352614
Name:ROOT PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:ROOT PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:NIKOLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:469-717-0329
Mailing Address - Street 1:8105 RASOR BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0267
Mailing Address - Country:US
Mailing Address - Phone:469-717-0329
Mailing Address - Fax:469-717-0327
Practice Address - Street 1:8105 RASOR BLVD STE 304
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0267
Practice Address - Country:US
Practice Address - Phone:469-717-0329
Practice Address - Fax:469-717-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty