MEDICARE: CYPRESS FORT WORTH LP

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1548204308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS FORT WORTH LP

Provider Business Mailing Address
First Line	:	2151 GREEN OAKS RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 GREEN OAKS RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1736
Country	:	US
Telephone Number	:	615-221-2250
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRYAN RICHARDSON
Credential	:
Telephone Number	:	615-221-2250

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/25/2008

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