| NPI | 1164172912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE TATE Credentialing 817-200-6492 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| 261QR0200X Clinic/Center, Radiology | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2022-03-25 |