MEDICARE: RHEA ALBERT PT

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	2251P0200X	Pediatric Physical Therapist	1129294	TX
2	225100000X	Physical Therapist	1129294	TX

General Provider Information

NPI Number	:	1588021372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHEA ALBERT PT

Provider Business Mailing Address
First Line	:	4865 FIREWOOD DR
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-3645
Country	:	US
Telephone Number	:	817-291-2907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4403
Country	:	US
Telephone Number	:	817-546-8661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	03/17/2018

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