Advanced Neuromuscular Performance & Physical Therapy LLC
Organization Active NPI Physical Therapy Clinic/Center · Keller, TX
NPI 1316476609 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1316476609
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- 1261798 (TX)
- Legal business name
- ADVANCED NEUROMUSCULAR PERFORMANCE & PHYSICAL THERAPY LLC
- Practice address
- 1211 S Main St Ste 500
Keller, TX 76248-0822 - Phone
- (770) 875-4985
- NPI assigned
- Jun 8, 2017
- Organization subpart
- No
Authorized official
- Name
- Kimberely Nicole Holloway, DPT
- Title
- Physical Therapist, Owner/Ceo
- Phone
- (770) 875-4985
Practitioners 1
-
Kimberely Holloway, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180410002846 | TX | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5092078774 |
Receives reassigned benefits from 1 practitioner Practice locations: Keller, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 1261798 | TX | Yes |
Addresses
Primary practice location
1211 S Main St Ste 500
Keller, TX 76248-0822
Mailing address
1211 S Main St Ste 500
Keller, TX 76248-0822
Phone (770) 875-4985
Other providers in Keller, TX
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- Gertrude Agyekum
- Aileen Wainwright, LCSW Inc.
All providers in Keller, TX · Physical Therapy Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.