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Organization
PHYSIOLOGIC, LLC
Active
Organization
PHYSIOLOGIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LEE PENA PT, DPT (MANAGING MEMBER)
(817) 366-5754
Entity
Organization
Contact information
Practice address
709 N FM 1187, ALEDO, TX 76008-4338
(817) 366-5754
Mailing address
7705 BRYCE CANYON DR W, FORT WORTH, TX 76137-4313
(682) 553-1913
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790431989
—
TX
05
—
1871020768
—
TX
Enumeration date
02/28/2022
Last updated
03/17/2025
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