MEDICARE: FORT WORTH REHAB GROUP

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	111N00000X	Chiropractor	8454	TX

General Provider Information

NPI Number	:	1821149733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WORTH REHAB GROUP

Provider Business Mailing Address
First Line	:	3523 MCKINNEY AVE
Second Line	:	# 246
City	:	DALLAS
State	:	TX
Zip	:	75204-1401
Country	:	US
Telephone Number	:	214-432-0910
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 N MAIN ST
Second Line	:	SUITE B
City	:	FORT WORTH
State	:	TX
Zip	:	76106-4344
Country	:	US
Telephone Number	:	817-624-4141
Fax Number	:	817-624-4227

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. BRANDI O'BANION
Credential	:
Telephone Number	:	214-432-0910

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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