Provider Demographics
NPI:1962550665
Name:FIRRA THERAPEUTICS, LLC
Entity type:Organization
Organization Name:FIRRA THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:CRUMMEY
Authorized Official - Last Name:FIRRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD
Authorized Official - Phone:214-348-3516
Mailing Address - Street 1:10557 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2269
Mailing Address - Country:US
Mailing Address - Phone:214-348-3516
Mailing Address - Fax:214-348-5727
Practice Address - Street 1:10557 CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238
Practice Address - Country:US
Practice Address - Phone:214-348-3516
Practice Address - Fax:214-348-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001667208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087663301Medicaid
TX824T52OtherBLUE CROSS BLUE SHIELD
TX824T52OtherBLUE CROSS BLUE SHIELD