| NPI | 1801812698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN B LACKEY Business Director 817-370-9891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: TX 605100000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 605100000) |
| 261QR0400X Clinic/Center, Rehabilitation (Licence: TX 605100000) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2014-05-20 |