Individual
EMMANUEL PREMPEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
896 SUMMIT ST STE 102, ROUND ROCK, TX 78664-4370
(512) 599-4262
Mailing address
896 SUMMIT STREET STE 102, ROUND ROCK, TX 78660
(512) 599-4262
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1222278
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031DG
BLUE CROSS BLUE SHIELD
—
05
—
0944746-02
—
TX
Enumeration date
10/03/2012
Last updated
03/26/2020
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