Healthcare Provider Details

I. General information

NPI: 1811102221
Provider Name (Legal Business Name): COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S DENTON TAP RD SUITE 100
COPPELL TX
75019-4098
US

IV. Provider business mailing address

580 S DENTON TAP RD SUITE 100
COPPELL TX
75019-4098
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JANNA KING
Title or Position: VP, AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000