MEDICARE: CHRIS PRATT DO PA

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA3439	OTHER		MEDICARE RR GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0076GV	OTHER	TX	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1932150570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS PRATT DO PA

Provider Business Mailing Address
First Line	:	PO BOX 33497
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76162-3497
Country	:	US
Telephone Number	:	817-423-3936
Fax Number	:	817-423-3941

Provider Business Practice Location Address
First Line	:	7800 OAKMONT BLVD
Second Line	:	SUITE 400
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4203
Country	:	US
Telephone Number	:	817-423-6582
Fax Number	:	817-423-3941

Authorized Official
Title or Position	:	OWNER
Name	:	CHRIS PRATT
Credential	:	DO
Telephone Number	:	817-423-3936

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/24/2007

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Directions to “CHRIS PRATT DO PA ” Practice Location

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