Provider Demographics
NPI:1619706215
Name:RESURGENCE PERFORMANCE AND REHABILITATION
Entity type:Organization
Organization Name:RESURGENCE PERFORMANCE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MARQUISE
Authorized Official - Last Name:MORRISSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:251-605-7915
Mailing Address - Street 1:3008 COYOTE WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2088
Mailing Address - Country:US
Mailing Address - Phone:251-605-7915
Mailing Address - Fax:
Practice Address - Street 1:3008 COYOTE WAY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-2088
Practice Address - Country:US
Practice Address - Phone:251-605-7915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty