Healthcare Provider Details

I. General information

NPI: 1265441075
Provider Name (Legal Business Name): SPORTS THERAPY AND ADVANCED REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 W HIGHWAY 71 STE 130
AUSTIN TX
78735-8260
US

IV. Provider business mailing address

7401 W HIGHWAY 71 STE 130
AUSTIN TX
78735-8260
US

V. Phone/Fax

Practice location:
  • Phone: 512-288-2700
  • Fax: 512-288-2711
Mailing address:
  • Phone: 512-288-2700
  • Fax: 512-288-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number651590000
License Number StateTX

VIII. Authorized Official

Name: MILISSA R BERRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 512-288-2700