Basic Information
| Provider Information | |||||||||
| NPI: | 1871712638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER LEWISVILLE THERAPY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 966 N GARDEN RIDGE BLVD | ||||||||
| Address2: | STE 530 | ||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75077 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 MIDWAY RD | ||||||||
| Address2: | STE 198 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727812322 | ||||||||
| FaxNumber: | 8443641302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | AITKEN | ||||||||
| AuthorizedOfficialFirstName: | DENA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER-GTC | ||||||||
| AuthorizedOfficialTelephone: | 9724206605 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.