Provider Demographics
NPI:1174062608
Name:THE KNEAD PHYSICAL MEDICINE, PA
Entity type:Organization
Organization Name:THE KNEAD PHYSICAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK HAWKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-213-2762
Mailing Address - Street 1:4944 PRESTON ROAD
Mailing Address - Street 2:STE 100A
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:469-213-2762
Mailing Address - Fax:
Practice Address - Street 1:13465 INWOOD RD
Practice Address - Street 2:STE 120-130
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244
Practice Address - Country:US
Practice Address - Phone:469-213-2762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty