MEDICARE: MRS. REBECCA KINZIE PTA

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	225200000X	Physical Therapy Assistant	2026995	TX

General Provider Information

NPI Number	:	1932648805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA KINZIE PTA

Provider Business Mailing Address
First Line	:	5000 WESTERN CENTER BLVD.
Second Line	:	STE. 220
City	:	FORT WORTH
State	:	TX
Zip	:	76137
Country	:	US
Telephone Number	:	817-514-0519
Fax Number	:	817-514-8861

Provider Business Practice Location Address
First Line	:	5000 WESTERN CENTER BLVD
Second Line	:	SUITE 220
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2197
Country	:	US
Telephone Number	:	817-514-0519
Fax Number	:	817-514-8861

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

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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