Organization
LEGACY PHYSICIANS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVEK SASTRY (OWNER/PRESIDENT)
(972) 668-5400
Entity
Organization
Contact information
Practice address
7460 WARREN PKWY, 160, FRISCO, TX 75034
(972) 668-5400
(972) 668-5401
Mailing address
7460 WARREN PKWY, 160, FRISCO, TX 75034
(972) 668-5400
(972) 668-5401
Taxonomy
Speciality
Code
Description
License number
State
364SR0400X
Rehabilitation Clinical Nurse Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790980
—
AZ
Enumeration date
12/19/2012
Last updated
03/13/2013
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