Provider Demographics
NPI:1245985175
Name:PHYSITEAM HEALTH LLC
Entity type:Organization
Organization Name:PHYSITEAM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEEGAN
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-284-8638
Mailing Address - Street 1:2517 RUSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2346
Mailing Address - Country:US
Mailing Address - Phone:214-284-8638
Mailing Address - Fax:833-606-1315
Practice Address - Street 1:2517 RUSSWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2346
Practice Address - Country:US
Practice Address - Phone:214-284-8638
Practice Address - Fax:833-606-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy