MEDICARE: DFW FTBC 1 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1023723970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DFW FTBC 1 LLC

Provider Business Mailing Address
First Line	:	3237 FORESTBROOK DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-2691
Country	:	US
Telephone Number	:	214-989-4148
Fax Number	:

Provider Business Practice Location Address
First Line	:	9665 N CENTRAL EXPY STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5073
Country	:	US
Telephone Number	:	214-989-4148
Fax Number	:	945-468-2882

Authorized Official
Title or Position	:	OWNER
Name	:	QUYNH NGUYEN
Credential	:
Telephone Number	:	214-989-4148

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	01/16/2023

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Directions to “DFW FTBC 1 LLC ” Practice Location

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