Basic Information
| Provider Information | |||||||||
| NPI: | 1730702101 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALING HANDS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FYZICAL THERAPY & BALANCE CENTERS ROANOKE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12460 WOODS EDGE TRL | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762449408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176370368 | ||||||||
| FaxNumber: | 6825092449 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 N OAK ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762626105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6825024440 | ||||||||
| FaxNumber: | 6825024440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2020 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRISSMAN | ||||||||
| AuthorizedOfficialFirstName: | DANIETA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6825024440 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PTA | ||||||||
| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.