Healthcare Provider Details
I. General information
NPI: 1164141545
Provider Name (Legal Business Name): MYPHYSIO PERFORMANCE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/26/2022
Last Update Date: 09/01/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1825 WIMBLEDON DR
ARLINGTON TX
76017-7920
US
IV. Provider business mailing address
4513 CALLA LILY DR
MANSFIELD TX
76063-6863
US
V. Phone/Fax
- Phone: 817-213-6087
- Fax: 888-271-0336
- Phone: 325-207-4704
- Fax: 888-271-0336
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2251X0800X |
| Taxonomy | Orthopedic Physical Therapist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
JARED
RYAN
CAVE
Title or Position: OWNER
Credential: PT, DPT
Phone: 817-213-6087