MEDICARE: TARRANT COUNTY INSTITUTE OF PHYSICAL MEDICINE LLP

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	:	1447669312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRANT COUNTY INSTITUTE OF PHYSICAL MEDICINE LLP

Provider Business Mailing Address
First Line	:	6901 RIVER PARK CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-8465
Country	:	US
Telephone Number	:	817-732-2171
Fax Number	:	817-732-2179

Provider Business Practice Location Address
First Line	:	6116 OAKBEND TRL
Second Line	:	SUITE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3925
Country	:	US
Telephone Number	:	817-346-7800
Fax Number	:	817-346-7804

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MARK H BUSSELL
Credential	:	MD
Telephone Number	:	817-346-7800

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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