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Organization
UPSTATE PHYSICAL THERAPY PC
Active
Organization
UPSTATE PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW LAWRENCE INFANZON P T (OWNER PHYSICAL THERAPIST)
(940) 483-9020
Entity
Organization
Contact information
Practice address
4401 NORTH I-35, SUITE 110, DENTON, TX 76207
(940) 483-9020
(940) 483-9021
Mailing address
4401 NORTH I-35, SUITE 110, DENTON, TX 76207
(940) 483-9020
(940) 483-9021
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
655410000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168705501
—
TX
01
—
4LV
BCBS OF TX GROUP NUMBER
TX
Enumeration date
09/15/2006
Last updated
04/18/2013
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