Dallas Federal Physical Therapy and Rehabilitation LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

DALLAS FEDERAL PHYSICAL THERAPY AND REHABILITATION LLC

Practice address

8204 Elmbrook Dr Ste 175
Dallas, TX 75247-7212

Phone

(469) 965-4505

NPI assigned

Jan 29, 2020

Last updated

Feb 3, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Willis II, MDNPI 1336142983

Title

Physician

Phone

(469) 965-4505

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles E Willis, MD

  • Pain Medicine Physician
  • Desoto, TX
  • NPI 1336142983
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1689205635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1347",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750011347",
            "telephone_number": "866-400-0476",
            "fax_number": "972-991-9548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8204 ELMBROOK DR STE 175",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752477212",
            "telephone_number": "469-965-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS FEDERAL PHYSICAL THERAPY AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "469-965-4505",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Dallas, TX
• Providers in Dallas, TX by specialty
• Physical Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.