| NPI | 1124025150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKE JASON HAYNES President 817-594-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: TX 652460000) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2013-04-12 |