Provider Demographics
NPI:1689212649
Name:MAXICARE THERAPY AND WELLNESS OF DALLAS
Entity type:Organization
Organization Name:MAXICARE THERAPY AND WELLNESS OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNABEL
Authorized Official - Middle Name:AQUINO
Authorized Official - Last Name:MANABAT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:773-853-1833
Mailing Address - Street 1:1533 HARVEST RUN DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4589
Mailing Address - Country:US
Mailing Address - Phone:214-774-2323
Mailing Address - Fax:469-375-8357
Practice Address - Street 1:1701 N COLLINS BLVD STE 330
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3602
Practice Address - Country:US
Practice Address - Phone:214-774-2323
Practice Address - Fax:469-375-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty