Organization
LEGACY PHYSIATRY GROUP LLC
Active
Other names
Legacy Physiatry Group LLC
Organization subpart
No
Provider details
NPI number
Authorized official
VENKATESH LAKSHMAN MD (OWNER/PRESIDENT)
(972) 881-4688
Entity
Organization
Contact information
Practice address
850 CENTRAL PKWY E STE 275, PLANO, TX 75074-5542
(972) 881-4688
(972) 668-5401
Mailing address
850 CENTRAL PKWY E, SUITE 275, PLANO, TX 75074
(972) 881-4688
(972) 668-5401
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203548701
—
TX
05
—
203548702
—
TX
01
—
D07564
RAILROAD MEDICARE PALMETTO GBA
TX
Enumeration date
03/08/2007
Last updated
10/05/2017
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