MEDICARE: DALLAS CENTRAL PHYSICAL THERAPY INC.

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	1020709	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598780496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS CENTRAL PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	PO BOX 911
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-2056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 1/2 W FRONT ST
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-2056
Country	:	US
Telephone Number	:	325-648-2350
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BILLY WAYNE CARROLL
Credential	:
Telephone Number	:	325-648-2350

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/13/2012

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