Provider Demographics
NPI:1982235131
Name:EMPOWERED PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EMPOWERED PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:214-940-8038
Mailing Address - Street 1:2112 BOLL ST APT 412
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2805
Mailing Address - Country:US
Mailing Address - Phone:214-940-8038
Mailing Address - Fax:
Practice Address - Street 1:1201 TURTLE CREEK BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-6613
Practice Address - Country:US
Practice Address - Phone:612-470-8618
Practice Address - Fax:214-594-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy