Healthcare Provider Details

I. General information

NPI: 1669490629
Provider Name (Legal Business Name): COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W BETHEL RD STE 400
COPPELL TX
75019-4473
US

IV. Provider business mailing address

413 W BETHEL RD STE 400
COPPELL TX
75019-4473
US

V. Phone/Fax

Practice location:
  • Phone: 972-304-9100
  • Fax: 972-304-9048
Mailing address:
  • Phone: 972-304-9100
  • Fax: 972-304-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP, AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000