MEDICARE: FORWARD PHYSIO FIX

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QH0100X	Health Service Clinic/Center
3	302R00000X	Health Maintenance Organization
4	305S00000X	Point of Service
5	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1619698511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORWARD PHYSIO FIX

Provider Business Mailing Address
First Line	:	3124 ATRIUM DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7019
Country	:	US
Telephone Number	:	214-276-1207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3124 ATRIUM DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7019
Country	:	US
Telephone Number	:	214-276-1207
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	JOSEPH NGUYEN
Credential	:	PT, DPT
Telephone Number	:	214-276-1207

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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