Provider Demographics
NPI:1699164640
Name:ADVANCED SPORTS REHAB OF FRISCO
Entity type:Organization
Organization Name:ADVANCED SPORTS REHAB OF FRISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-932-7066
Mailing Address - Street 1:12021 DALLAS PKWY
Mailing Address - Street 2:STE. 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12021 DALLAS PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3677
Practice Address - Country:US
Practice Address - Phone:972-578-2225
Practice Address - Fax:972-578-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty