Fountain Life Dallas, LLC
NPI #1336829514 in The Colony, Texas
Provider Information
- NPI Number
- 1336829514
- Entity Type
- Organization
- Organization Name
- Fountain Life Dallas, LLC
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Jul 21, 2023
- Last Updated
- Jul 21, 2023
Practice Location
- Address
- 5762 GRANDSCAPE BLVD STE 115
- City
- The Colony
- State
- Texas
- ZIP Code
- 75056-6782
- Phone
- (469) 669-0336
Authorized Official
- Name
- BARBARA WOO
- Title
- DIRECTOR OF CLINICAL OPERATIONS
- Phone
- (917) 810-8672
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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